HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
—61 �
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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:
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Address: sp r eL( e, g
Property Tax ID#: _ / 1 � �,- ��. -- ® � Lot No.�
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 6 �50 ; 0 C Utilities: —Sewer —Septic Building Height:
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OWIIIER LESSEE51,11.'.
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Name n` Name:T- b Jl_ lI Le VJ i S
Address: f� G Company: Ori5r)^ jr.0 e'iC_ i1C
City: r–flC State:E/ Address: _78 i ( C'+t,i4C f der L-��
Zip Code: � Ci - �t Fax: City !C r-&\ State:/
Phone No. % Zip Code: .., 7 Com: Fax- 7' �G�"�� 77,5
E-Mail: Phone No '72 Lin '9�46
Fill In fee simple Title Holder on next page(if different E-Mail ,; 1 e C J C & - /i i iC r ('c 6I7
from the Owner listed above) State or County License • el
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.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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 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 SIITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Cont actor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �� STATE OF FLORIDA
COUNTY OF ` COUNTY OF So-\-L
The forgoing instrumgrat wps acknowledged before me The forgoing instrument was acknowledged before me
this day of 'y �� 20 'L c�y this day of dl�(Q 20 2-0 by
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Name of person making statement. Name of person making statement. c
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification n
Produced L L Produced !—L 1J L
o c _._. vc
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Frdrida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2 7/19