HomeMy WebLinkAboutAvery Permit Application St Lucie CountyAll APPLICABLE INO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i 111)OW 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 X
PERMIT TYPE:
7777�
PRO"'
Af4rncc-
Property Tax ID #: � Lot No.
Site Plan Name
Project Name:
Additional work to be performed under this permit —check all that apply:
—Mechanical — Gas Tank — Gas Piping — Shutters Windows/Doors
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction. $ \ CD
Name
Address: 0(o
City: LC'X' ()�"Ct State:
Zip Code: L- ( C) — �
-D Fax:
Phone No. 15-C-2 c22ST-2,
E-Mail:
Generator Roof Pitch
So. Ft. of First Floor: C' CC,
Utilities: —Sewer _Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City:`�
State:
Zip Code: Fax:
Phone No
E-Mail ca)
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:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: ; _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: ` State:
Zip: Phone
FEE SIMPLE TITLE HOLD: _ 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
WrFH YOUR ii FNnFR c%B AN eTrnRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
.- 044��?6
Signature of Owner sect ontractor as Agent for Owner
Signature of Contractor ►cense Holder
I
STATE OF FLORID
STATE OF FLORI r
COUNTY OF
COUNTY OF
The f�{roing instruf ent as acknowledefore me
this day of. 2 by
The foing instr Event as acknowledg Before me
this day of f 2 by
Name of person making statement.
Name of person making staltement.
Persona ly Known OR Produced Identification
Personall Known OR Produced Identification
Type odentificat' n ,
Ty f I entificati n �,
Pr d F
P du e' _
Signature oftiojaWPubli iWTARYPUSLIC
(Signature of o a!Pubir' PUBLIC
STATE OF FIAOMDA
^ STATE OF FL
Commission No.
Commission No. CkiW W(111602",i0
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW .
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19