HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON'.. , rED FOR APPLICATION TO BE ACCEPTEL.
Permit Number: �ed:?I —fq/ky
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
PERMIT TYPE:
Residential v
PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID#: VY499-80/-b0/3'a00-7 Lot No. /3
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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: / 939 Sq. Ft. of First Floor: / 939
Cost of Construction:$ 4o1).00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name /en.,
Name: n
Address:
Company:.` /t9ounPr
City: i f I'erce- Stater
Zip Code: Fax:
Phone No.
Address: / S[ a r
City: 'eree Stater
Zip Code: 2A-/9e-9 Fax:
Phone No
E-Mail: QwsneecL�! e//5au fC . ✓!e
Fill in fee simple on next page ( if different
from the Owner listed above)
E-Mail q cat S h &&J t,0 Q��S oui� . ✓/e
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 CONSTRU"N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
t-' Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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
WIITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signatu of ner/ Lessee/Cot actor as Agent for Owner
Signature of Contractor/license Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF�—
COUNTY OF
The forgoing instrumentt w s acknowledged before me
The forgoing instrument was acknowledged before me
this day of / 20ZAy
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificetio
Type of Identification
Produced
Produced
ignature of Notary Public- Florida)
SrS'
o ^
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
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Commission No. (Seal)
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REVIEWS
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PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
REVIEW
DATE-
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RECEIVED
DATE
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COMPLETED
Rev.2/7/19