HomeMy WebLinkAboutBuilding permit applicationk,6^,7rA4S @S7L4 c `c Co,, +CSG
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 0
C IST -
F L 0 R I D A
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address:
Property Tax ID #:
Site Plan Name: 4
Permit Number:
Building Permit Application
Commercial _. Residential
Additional work to be perfor ed under this pzGas–Pipine
.t check all that apply:
_Mechanical las Tank _ Shutters
_ Electric Plumbing g —Sprinklers _Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: _Sewer _Septic
Name
City' Wk
State: �
Zip Code: 3N3 QD Fax:
Phone No.li _14.3
E -Mail: 221q , L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company:.
Address:
Lot No. LD
Block No.
_ windows/Doors
—Roof Pitch
Building Height:
city' Cr7y State:
Zip Code: b Fax:
Phone No
E -Mail Vt (,aKo ill •
State or County License OSS9 Y
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.
SUPP,I{74C CSV' UCTOWLIEN #mow
DESIGNER/ENGINEER:
Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: No
Name: t Applicable
Address:
City:
Zip:Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip:
BONDING COMPANY: Not Applicable
Name:
Address:
City -
Zip: .
ity: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 VAPROVEMENTS TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST yVWECnON. F YOU INTEND TO OBTAIN FINANCING, CONSULT
1MfTH YOUR LENDER OR AN ATTORNEY BEFORE RECOp� YOUR NOTICE. OF COMMENCEMENT"
5ignatu f Owner/ Lessee/Contractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF jC,� COUNTY OF
The fgrgoing instr nt was acknowledged before me—
this X day of 2 The forgoing instr was acknowled gd before me
by this day of L. 2� by
Name of person making statement.
Name of person making statement.
Personally Known �_ OR Produced Identification Personal) Known_
Type of Identification y OR Produced Identification
Produced Type of Identification
Produced
(signature of Notary Pub TTANY R E D D l N
gnature of Nota Public
Y vG�r
Commission NState o{ Fiarid8
-Notary Pu Ilc Y r BRITTANY REDDIN
_ g6�pj,ssion # GG 191728
My Commission Expire C mission No: ;Stat��% lorida-Notary Pu
''•,,`; ,,i.February 26, 2422 Commission # GG 19028
My Commission Expire
REVIEWS IFRONT ZONING
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
SUPERVISOR I PS VEGETATION SEA TURTLE MANGROVE
REVIEW RLANEVIEW I REVIEW REVIEW REVIEW