HomeMy WebLinkAboutBuilding Permit Application1
All APPLICPlBLE JNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G
Dater Permit Number: Z&O Z — 6Z / 6
-__ __- --- -01-00 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
PERMITTYPE:
Add
Property Tax ID #:
Site Plan Name: t
Project Name:_
Lot No.
a c=—O i 5 Block No.
Additional work to be performed under this permit—'Fhec ' all t i Iy:
_Mechanical _ Gas Tank _ Gas Piping _ hutters
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction: ,,�
Cost of Construction: $ �-/Jgcp • W
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRAGTOR;
Name `Lf
Name:
Compa
(Address
City,e�:
Zip Cod
E ,_
Phone'
IE, Mail`"'
State or
Address�0) 9(-y V-k�
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City: T 1 - 1'I���i State
Zip Code: Fax: ,
PhoneNo.71l --109—,Q�1-t!�
State:_
E-Mail: (�!
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
nt is If value of HVAL is $7,500 or more, a RECORDED Notice of Commencemerequired.
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S PPLEME RALROWN'STITRU
DESIGNER/ENGINEER:
Name:
ON L E tAW
Not Applicable
A I I N
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
ate:
Z
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY _Not Applicable
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 andcovenantsthat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
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In consideration of the granting of this requested permit, I do hereby agree that Twill, 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
WITM Vn. In 1 CWn=n ^n An AT nnWC GC=nn= n=IYnnnIM/` Vnff In Yf1Tlf C AC Pn YYCn/'CYCYT iI
as Agent for s I Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me'; - .•..
this day of 20_ by . _ _, .+
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public- State of Florida ) 1�
Commission No. (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
6
A
OF FLORIDA
fY OF
The forgoing instrument was acknowledged before me
this - day of, 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
M
(Seal)
PLANS E EW I VEGETATION I S REVIEW I MANGROVE