HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
PERMIT TYPE: 14 VA C,
PROPOSED IMPROVEMENT LOCATION:
Address: , 2M
Property Tax ID #:' 2�1� ���- " "�� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ Z, 3 vo
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name �O%f'1
Name: eff l
G
Address: 16 UJ
Company: /
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City: '~ S1 , Lu6ie Stater
Zip Code: Fax:
Phone No.'9(W— 72, —'�L�
Address: L�F
City: r1w-t Sf. lG e Pi
Zip Code: S`�
Phone No
Fax: '%1,7,2
? C" /5 /
State:
— 3�S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail /- i G`43
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, L�11�%
State or County Licensees ea --
if value of construction is $2500 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.
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DESIGNER/ENGINEER:
— Not Applicable
MORTGAGE COMPANY:
— Not Applicable
Name:
Name:
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
WIT14 Yn"R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Si Owner/ Lessee/(ontractor as Agent for Owner
Sign l (f Contractor/License Holder
STATE OF FLORIDA
41
STATE OF FLORIDA
C.00N�'\
COUNTY OF 5-�- Luc it CIL)kOa
COUNTY OF L.vciE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 3oday oJf� SA Ati1 20aa by
this3o day of , 20� by
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Name of person making statement.
Name of person making st tement.
Personally Known ✓ OR Produced Identification
Personally Known 7 OR Produced Identification
Type of Identification
Type of Identification
Produced
la*� ll���i.
Produced
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(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commiss NO. A WALSH
Commissi
;� '�; �.,,ANDRA WAL H
:State of Florida -Notary Public
?_°,-State of Fiorida-Notary Public
REVIE
RON Commission
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PERVISOR
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REVIEW
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DATE
RECEIVED
DATE
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Rev.12/7/19