HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr
Date: I l 2 Permit Number:
.e RECEIVED
COUNTY
Building Permit Application
NOV 2 2
Planning and Development Services sT.. Luzie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PR�POSED IMPROVEMENT LOCATION
Address.
PropertyTax ID#: ���� I (®.; ON 606 (yz Lot No.
Site Plan Name: Block No.
Project Name:
DETAILEDc�D.�E5CR'iPTION j
�51 <1 1 �II 2 0 c S C f G7if yl /� (< Le-
CONSTRUCTIONI INFORMA ION:
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:$ 2.I SOp d- Utilities: —Sewer —Septic Building Height:
MUM N =R/LESSEE: CONTRACT+R: ,
Name RNZ--f ' Name:
Address: 14((? Moa^)'V-yo.\.
State:pN� Address..;..• -.�@ r ' �- -�
' ZFa{x:ip'Code: 2`�3� itY^ Stater—�
1
Phone Nb"?
Zi'
27 Fax:Faz: -�
�.E-Mail: .r,:,: a: =:. •> Phone No
Fill in fee simple Title Holder on next page(if different E-Mail t f
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.
SUPPLEMEN AL CONSTRUCTIONNINALAW IiNF RiMATION.
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:
OWNER/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, I 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 BE RECORDED AND
POSTED HE JOB SITE BEFORE THE FIRST INSPECTION YOU INTEND TO OBTAIN FINANCING, CONSULT
W1 OUR LENDE AN ATTORNEY BEFORE RECORDI YO eR/a�,NOTICE OMMENCEMENT."
Signature 0 n L e/Contractor as Agent for Owner S ure,o on ac%o� ense Holder
ST E O LORIDA STATE LORI,
C OF �„LLr✓t� coo OF W-e-ce
The for oing instrument was acknowledged before me The forgoing instru�@ nt was ac nowledged before me
tday of NJ)J� e.d;20� by this��day of IV�o�e�. e�20� by
his
Name of person m king statement. Name of person mak-A statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
%
(Signature of No Pub (Signature of Not Public- a f FI i
r P�•.,• AMY M.BOYD
�� ?a°, �� Notay `ic State of Florida ``�L ;,- Pu :" MY M.BOYD
Commission No. , ii` C m�m ion N GG 301818 Commission No.�C� :°. .�,;_.
My Comm.Expires Apr 1,2023 N� issic-State of 3018 18��� •a`' Commission k GG 301618
r Assn. '2OF
my Co-
Bonded throw h National Notar Assn
REVIEWS FRON ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19