HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ Permit Number:
- ,.Building Permit Application- -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Comm' erCial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: (0604. 10 Cacl_ AvQ I C-0"C rL
Property Tax ID M. Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION,OF WORK:
Wince. &QiYL wk.. nxn� CJ 7
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit.— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator - _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ LJ Utilities: ` Sewer _ Septic Building Height:
OWNER/LESSEE: , =
CONTRACTOR-
Name
Name: '—
Company;C�`,ffi,,�,,,�> Z-1 , seeka'f1U
Address: G
City: State::-L..
Address6,L,x-1
Cit FA V.I s ° - Z
State:�-
Zip Code: 3 L14•s i "Fa
-Phone No.' f
,Zip Code:. ( �� ��`\
Fax-.'
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E-Mail:
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Phone`No
Fill in fee simple.Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION'..-:
DESIGNER/ENGINEER:.
Not Applicable
MORTGAGE COMPANY•.
_ Not Applicable
Name:
'Name;
Address:
Address:
City:
State:
City:
State;
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OVVNERJ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit. --
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such .
structure. Please consult with your Home Owners Association and review your deed for any. restrictions which may apply.
In consideration of the granting of this requested permit, 1 do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST' SE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN -FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
F N
Sign ure of Owner/ L see/Contractor as Agent for Owner
SignaWFe of Contractor/License Holder
.•i
STATE OF FLORIDA
COUNTY OF 1(Y�� 1�1 l �I t�
STATE OF FLO �IDral Q --Y1
COUNTY OF
The forgoing instrument -was a kn$wI !dg efore me
this day L% "I,
The fo going instrumen was a kn wledg efore me
� i� �20 °
of 20by
this day of by
Name f person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
l I Il A An A A
Produced
,
(Signature of Notary Public- State of Florida)
(Signature of Notary P - -t,� F idea
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Noll C 1%=�=Mate
Ism sion No (SeaCommission
of Florida-Nofa
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REVIEW
REVIEW
-REVIEW.
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/ // 19