HomeMy WebLinkAboutbuidling permitAll APPLICABLE I IFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C t� 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 Commercial Residential V
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCH
ON:
Address:
WMI
Property Tax ID ##: -S-3 Z—Y 9403�•— 6 c Lot No. ?_
Site Plan Name: Block No.
Project Name: 10- t S
DETAILED DESCRIPTION OF WORK: r
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters
Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r I S
Name:
�i
Address: �� ` fCc� 1 LAi br. .
Company:
City: n (e- rce State: _FL
Zip Code: G�/Z Fax:
Phone No.
Address: l c1Yo
Cityv I C.4-" QL State:
Zip Code:.--W!2 Fax: �7 7-23i6 T
Phone No —e?-
E-Mail:
Fill in fee simple Title Holder on next page t if different
from the Owner listed above)
E-Mail ele `,
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State or County License
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If value of construction is 52500 or more, a RECORDED Notice of Commencement is requirea.
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
Name:
MORTGAGE COMPANY: L Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: of Applicable
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 FINA LING, CONSULT
�rITw Yni iw i FNDFp nu AN airTnRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT
Signature of neContractor as Agent for Owner
Sig ure of C n tact /License Holder
STATE OF FLO A f
COUNTY OF °�
STATE OF FLORID
COUNTY OF � � �-
The f ing instrume s acknowledged before me
�
The forg ng instru nt was acknowledged before me
this of of 26,& by
this day of 202- y
Name of erson making statement.
Name o4erson making statement.
Personally Known OR Produced Identification
Personally Known L-- OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(signature of Not Public- State of Florida
(Sinature of Notary Public- State of Florida )
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SEATURTLE
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19