HomeMy WebLinkAboutBuilding Permit Application_
All APPLICABLE INFO MUST RE�arvlPLETEQFOR APPLICATION TOBEA[CEpTIED
Date: PenmitNurnbec
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
Z3O0Virginia Avenue, Fort Pierce Fl3498Z
Phone: /77l\462'1S5S Fax: (77I)46Z-1578 COOONDerCia| Residential
TIP
PROP EiWd�.A
Address: \L/
Property Tax |D#:
Site Plan Name:
__
Project Name: ___
Additional work tnbeperformed under this permit— check all that apply:
�y^K8echanica| 6asTank Gas Piping __Shutters
__Electric Plumbing Sprinklers __Generator
Total Sq. FtufConstruction: Sq. Ft. ofFirst Floor: ___
Cost ofConstruction: $ Utilities: —Sewer _Septic
Lot No.
Block No.
__Windows/Doors
Roof Phzh
Building Height:
Zip Code: �3L'l C1 BU Fax:
City: Af,)-V4+—
State: -ELL —
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail J
nd, f ny�
State or County License
If value of construction is $2500 or more, a RECORDED Notice ot Commencement is requirea.
SUPPLENtENTAL CON5
TION'LI1 N LAIN INFOftMATiQN
k
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 roams 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 RECORDIM YOUR NOTICO OF C*QMMENCE,(NENT,."
of
for Owner
se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF�1(jAI,) COUNTY OF � n
instrurpent was acknowledged before me
of;A(1( IC)AT.20?� by
person making statement.
y Known —A/— OR Produced Identification
f Notary Public- State of Floridal)
No.bbD35RCO (Seal)
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
The for oing instru dent was acknowledged before
this3adayof 110r)JAVk 2020 by
t. A
Name of person making
gsstatement. '
Personally Known V OR Produced
Type of Identification Produced —
(Signature of Notary Public- State of
Commission No. () (Seal)
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