HomeMy WebLinkAboutBuidling PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number:
Building Permit Application
Commercial Residential V
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 00%� -Coo-0 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
I. CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank Gas Piping Shutters Windows/Doors
_ Electric Q,IPlumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First floor:
Cost of Construction: $ -750 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: , ,i4o-juxkoy
Address: JQ,20 n
Company:
City: sux�......__.. State:""-
o
Zip Coder Fax:
Phone No.
Address:-
City:L1.4 t�4_ State: tL.
Zip Code: _�� Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
Name:_
Address:
City: _
Zip:
Phone
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
OWNED/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 requester! 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-AF COMMENCEMENT-"
Signature of caner/ esseef Contractor as Agent for Owner
Signature of Contra or%License Holder
5i
STATE OF FLORIDA -
COUNTY OF �-� e
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STATE OF FLORID
COUNTY OF
The f9r,oing instr e t as ac. owledgo efore me
this : ay Qf C 2r�by
The for�oing instru t ark w dge before me
this_ � r day O
l /�y
Name of person making statement.
Name of person making statement.
VOR
i
Personally Known Produced identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ignature of Notary - tate of Florida
4signature of N lic- State of Florida }
Commission No. Seal
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commission No. (seal)
l`rNt N maga
44
Ele.Commission
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DATE
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