HomeMy WebLinkAboutBuilding Permit ApplicationAll -APPLICABLE INP M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/ �`�' Permit Number:
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 Residential
Property Tax ID #: I`� 3 ` - b�Zo C7b� "`� Lot No.
Site Plan Name:.?(34 Its. ��. �{- �- a� S Kiw S'T &Z:` v a? P lnl G Block No.
Project Name:C
C0NSTRUCTION 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: ��, r-0y Sq. Ft. of First Floor:
Cost of Construction: $lL Utilities: —Sewer Septic Building Height: t�
• ER/LESSE.
C�INTRACTCiR;
Name
Names ( a .
Addres -7�.
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S te: �
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Address LI S�ietnJ��/n
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Zip C,
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f 7 = Zip Cdd'e:3115 5= Fax:
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E-Mail:r✓l�
Fill in fee simple Title Holder on next page ( if different
E-Mail ✓ /3n/cam - cey. Cur,
State or County License CMG /2�a
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requir`e7.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN' IN2 L CONSTRUCTiON ifN LAW INFORMATiaN:
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
is in
which 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 LENDE OR AN ORNEY BEFORE RECORDING YOUR NOTI(;EOF COMMENCEMENT:'
.Signature of Owner/ Lessee/Con &for as Agent for Owner
Signature of Contractor/ cens older
STATE OF FLORIDA
STATE OF FLORIDA _
COUNTY OF ,� oe
COUNTY OF 5L�A 0
The forgoing in ru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this � ddaay oA 2� by
``1
this _ day of 20�y
pn�
' 0 f J1 X, Q21
Name of person making statement.
Name of person making statemen
Personally Known OR Produced Identification
\ `
Personally Known OR Produced Identificationy
Type of Identification
Type of Identification
Produce
Produced
Signa ro of Notary Public-
' ature of N r.
: a,.•• �,., LASNAHNA INGRgIy.
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F'oP°' EXPIRES: December
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Indervidters
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REVIEWS FRONT ZONING SUPERVISOR
PLA
VEGETATION
V OVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19