HomeMy WebLinkAboutApplicationEx-emo-A- P(nne(-4q
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Muni
•
Agriculture Exempt Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Fierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
1A
Property Tax ID #: S�" )17 1 0C _0 ---- -- - Lot
Project Name: �`�� i e G c_ r'1
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Utilities: —Sewer Septic Sq. Ft. of First Floor:
Cost of Construction: $ _ e_ Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
floodplain:
Nonresidential Farm Building: Temp. Bldg./Shed used exclusively for construction
Mobile/Modular for temp. construction office: Bldg. involved in distrib. of electricity:
Other: Flood Zone: BFE: Floodway? Y/N If Y,
No Rise Certificate with supporting data attached? Y/N
All other applicable state and federal permits shall be obtained prior to commencement of
construction.
OWNER/LESSEE: _ �!- ~CONTRACTOR:
Name ` �_ Ll� C C� S 1 Name: _
T
i Address: C� cc, C �-�ea ZC _ i Company:
City�� �..�-L�1� �c= State: rG, Address:
Zip Code: SA axR3 City: State:__...__
Phone No. ��`� C`�(.; �-" �� C' c- Zip Code: Fax: --
E-Mail: t m ��M CAC,kW C666N\ Phone No -
Fill in fee simple Title Holder on next page ( if different E -Mail_
from the Owner listed above) j State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
1
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL TAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/EN EER: Not Applicable
MORTGAGE CO ANY: No pplicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phoa
Zip: Phone:
FEE SIMPLE TITLE HO E • Not Applicable
BONDING COMPANY Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: XJ 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 thepermit 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT_"
ev.
Y 0
Signature of Owner/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder {
STATE OF FLORIDASTATE
�A U k <, e,
OF FLORIDA
COUNTY OF .
COUNTY OF
The forgoing instrument was acknowled d before me
this day of VIN. 2
The forgoing instrument was acknowledged before me
this day 20 by
lc , y
of
Name of person makin statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
otary P
(Signature of Notary Public- State of Florida )
•""' '' BRANDY NICOLE GUETR
Commission N taryp��lk�StateofF�orida
Com tGG118i47
Commission No. (Seal)
My Comm. Expires !un 22.2021
.QCs r.Me d FtWar,A11r.
REVIEWS
FRONT
ZONING SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
---I
DATE
COMPLETED
ev.