HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP ED FOR APPLICATION TO BE ACCEPTED
Date:
1 J _
•
Planning and Development Services
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEUENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:_
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Permit Number:
Building Permit Application
Commercial Residential
FM
Additional work to be performed under this permit —check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters
_Electric %Xplumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 11 [ J,
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic BuildineHeieht
OWNER LESSEE:
CONTRACTOR:
Name
Name: sO
Addre
Company..
4St4ate:_
_
City: State:/jr
Zip de: C(�j(10 Fax:
Phone No.
Addre
City:
Zip Code:A r_,_ Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
If value of construction is S�srn or mn.n � o«�o��� ._.:__ _
E-Mail
State or County License
. equireo.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNS
Name:_
Address:
City: —
Zip: Phone
— Not Applicable
State,
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: tate:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:`
Zip:
Phone:
Not Applicable
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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
d!F J.Al r_�, '4
Signature f Owner/ Lessee/ tractor as Agent for Owner 5igna r of Contractor/Lice a Holder
STATE OF FLORIDA COUNTY OF STATE OF FLORID
COUNTY OF
Th`rgaing instrum nt was acknowlecig d afore me The o�rgoing instrument w s acknowledg d {pre me
thi �� day of�� 2obY tfti�7 day of Zp
Y
name oT person snaking statement.
Personally Known
Type of Identification
Produced
C
(Signature of Nota(' Pub
Commission No. ��
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
OR Produced Identification
FRONT
COUNTER
Sta3WfeFforida T4'
• ���•y �o�de�d *X!
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Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced P
(Signature of Nota Publi `Stale lorida
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Commission No.�f�,al� 7k
)AERViSOR I PLANS
REVIEW REVIEW
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