HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ))
Date: Permit Number: [q
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
Address: I `1 0.4 F' ne 1. 0. f" I e/C
Property Tax ID #: I Sam -101 -coke • 0003
Site Plan Name:
Project Name:
3000 P5-1 /Ci6E�rnESli �Qrrt
l L. / Q 'k is n �N la� �P � oC 651d, Ael erid,-r 0,1 �y .
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank l_ Gas Piping _ Shutters
Electric —Plumbing Ill_ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6 SOd Utilities: —Sewer —Septic
Lot No.
Block No.
Windows/Doors
--Roof ' Pitch
Building Height:
CONT
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Name: i .(C lac//ss:
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Company: �r,� e�r�n
City: State: 1'L
Zip Code: i.',
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Phone No',
Address:___ ugQ6 fAdfrD e'
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Zip Code r,3.N,�SJ_
Phone No
E-Mail: :;� R�-a,,J;�. ,•
Fill in fee sime -Holder on next page ( if different
from the Owner listed above)
E-Mail CS -IM`Ar
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.
DESIGNER/EN,GINEE
Name:_
Address:
City:
Zip:
N
Phone
" % Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name:_
Address:
State: City:
Zip:
FEE SIMPLE TITLY HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
te:
Not Applicable
OWNER/ CONTRACTOR AFFIDAVIT: 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."
Signatui4e of Owner Le ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA l
STATE OF FLORIDA
COUNTY OF%
COUNTY OF
4=��
The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
this. day of '(J� o, 20_& by
thi- day of 20 e by
Name of 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
Produced
(Signature of Notary Public- to of. Florida) .
(Signature of Notary Public - State of Florida )
Commission No. (Seal)
Commission N Seal
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Rev. 2/7/19