HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 Commercial Residential
PERMIT TYPE:
Address: hC&Property Tax lD
ofUNo.
SII<e� ' Block No.
P,tr
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Additional work to be performed under this permit—check all that apply:
iMechanical _, Gas Tank Gas Piping ShuttersWidow
Doors
_Electric Plumbing Sprinklers _ Generator Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ s i'— Utilities: —Sewer _Septic. Building Height:
441125/)4
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Address: Company
City Sta fg Address• 1
Zip Code: Stafe
Phone No. Zip Code• f.�ec
E-Mail: Phone Ng
Fill in fee simple Title Holder on next page(if different E-Mail f 0 nPS V 0 AP l tl WA
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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 ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR 19ftER OR AN ATTORNEY BEFORE RECORDING YOUR NOTIC F COMMENCEMENT."
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V1)666u, — /- UWZ,�el -
_ Signature ofr0RIDA
Ye' /Contractor-as Agent for Owner Signature ofZLORIDA
Factor/Li cense Holder-
STATE OF 1 STATE OF �_.�
COUNTY OF _S L UCI(� COUNTY OF `.!
The fo ing instrurpent was cknowledge¢before me The forgoing instru i was,acknowledgg efore me
this day of �„ € �v,�: 20_4 by this day of I�� '�/Illl z0 U by
Name of person makings tement. Name of person ma:70R
ement.
Personally Known b_ OR Produced Identification Personally Known Produced Identification
Type of Identification Type of Identification
Produced Produced
Ph A V)
(Slgn4fure of Notary Public-State of ERIN R.MILLER (Signa ure of-/Not ary'Pujlic�-State da) ERIN R.M�
Commission No{, C-11" , �_ * Commisslon#GG 28 856 ( C mission9GG283815
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of Fair 0*n-MTlw10uWNWola aor:n.P. BcffdMTEN6aQyMtbp�'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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