HomeMy WebLinkAboutbuilding permitAIIAPPLI MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulotion Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-:-sss Fax: {772) 462-1578 Commercial _ Residential
Property Tax lD #:
Site Plan Name:
Lot No.
Block No.
Project Name:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Sprinklers
_ Shutters _ Windows/Doors
,zftlectric _ Plumbing _ Generator
-
Roof
-
Pitch
Ft. of First Floor:Total Sq. Ft of Construction:Sq.
Utilities:Cost of Construction: S _ Sewer _ Septic Building Height:
lf value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
lf value of HVAC is 57,500 or more, a RECORDED Notice of Commencement is required.
PERMIT TYPE:
Zip code: 3J 9O )- rax:
Phone No
E-Mail
-fsr- /s?
State or c6unty ticense FC
Address:
Zip Code:
E-Mail:
Fill in fee simple Holder page ( if different
from the Owner listed above)
Address:
CONSTRUCTION INFORMATION :
PROPOSED IMPROVEMENT floN:
DETAILED DESCRIPTION OF WORK:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
-
Not Applicable
Name:
Phone:
FEE SIMPLE TITLE HOLDER: __ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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 Countv makes no representation that is srantins a oermit will authorize the oermit holder to build the subiect structure
which is in conflict with anv dpplicable Home Owilers AsSociation rules. bvlaws or and covenants that mav restrict or prohibit such
structure. Please consult With iour Home Owners Associatioh and review'youi deed for any restrictions r,rihich 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 FATLURE To RECoRD A NoucE oF coMMENcEMENT MAy RESULT IN youR PAYTNG
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY" A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB S|TE BEFORE THE FTRST |NSPECT|ON. tF yOU TNTEND TO OBTATN FINANCTNG, CONSULT
}YITH YOUR RECORDING YOUR NOTICEAN
Signature of Owner/ LesseelContractor as Agent for Owner
STATE OF FLORIDA T /
COUNTY OF r\a-a)F- L.,. ,]
#,iw;:r'zl"Wu!"t'o"o*t?f#;f "*"
Personally Known ,r/ OR Produced ldentification
Type of Identification
Produced
Commission No.
of person making statement.
Public- State of Florida )
Signature of Contr
srArE oF FLORTDAQ l',l / ,COUNTYOF N,zuj-fA Lvrcr'f
The forgoing instru.as acknowledged before me
this ZL day of
*t ,aN lN, c1'7^t
Name of person making statement.
Personally Known t OR Produced ldentification
y Public- State of Florida )
goBorHY4SH#+sKlN
MY CoMMISSIoN # GG 030145
EXPIRES: October 2, 2020
REVIEWCOUNTER
COMPLETED
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Address:
City:_Zip:_
Citv:
Address:
Citv:
Zip: _ Phone:_zip:
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