HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:(7�lJlJ • �� ��
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial z Residential
PERMIT TYPE: Flec:�cc. �
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RROPOSED IIVIPR®U�E.I i N LOCATION � "
Address:
Property Tax -ID #: Lot No.�_
Plan Name:
Name:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank Gas Piping Shutters
— Electric — Plumbing —
Total Sq. Ft of Construction: Q
Cost of'Construction: $ �P
Sprinklers — Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Block No.
Windows/Doors
Roof Pitch
Building Height:
O,&NER7�LESSE�E�tO
INI"RACTOR>• s
Name
Name: .jCAme—s
jAddress: C9
Company:"(6&
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City: ` r0� e"
State:4k,
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Address: \O\O hJ
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City: ��;�\ �G�(C�
State:
Zip Code: ����� Fax:
Phone No, Q 3L\- aga-(91aa
Zip Code: 2)1*aC&2L Fax:
E-Mail:
Phone No 'A Zo \-93-a-9
Fill in fee simple Title Holder on next page ( if different
E-Mail_ Scc�AL&SO
) 06
COP, —
'from the Owner listed above)
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State or County License
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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/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: -
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
Ini, consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
ini 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."
Owner/ Lessee/Contractbr as Agent for Owner I SignatN of
STATE OF FLORIDA STATE OF FLORIDA 1
,COUNTY OF Hai roe g , COUNTY OF -M
i
,The forgoing,instr ent was acknowledged before me
this day of 20Q Cby
Name o person making statement.
Personally Known V OR Produced Identification
Type of Identification
Produced
ignStu-re of Notary Publi(PState of Florida )
Commission No.
REVIEWS
DATE
RECEIVED'
COMPLETED
PT 7777T4
MY COMMISSION # GG 215060
er
The forgoing instr 9gent was acknowledged before me
this l day of 24D by
Name r person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
&IA�2
(SikKat6re of Notary Publi State of Florid
Commission No. (Seal)
LASHAHNA
CO LATER REVIEW' _ REVIEW�R I REVIEt/ Ei�!(�ES�
MANGROVE
REVIEW