HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FDR APPLICATION'-TO BE ACCEPTED
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5` . 1 Permt`'Nunber: B day�d��6
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Aim N AY 2 7 2020
Building'Permit Application
4T. Lucie County, Permitting
Planning and`Developrnent5ervices i _ _ _ _ _ _
Budding and Code Regttldtion Division
2300 Virg►nra Avenue,'FOrt Pierce FL 34982
Phone (772)'462 1553 Fax (772)462-1s7s Commercial Residential, .
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Additional work to be performed under, is permit check all'that apply
Mechanical; _Gas Tank Gas Piping .- _Shutters Wrndows/Doors:
ElectriC-
um lng. _Sprinklers Generator _Roof Pitch
Total Sq`Ft of`Constructron: Sq.`F.t:of'First Floor .
Cost of Construction $_ •- Utilities Sewer, 5eptrc Building Height
77
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Name `.Iti o l .r e►'l VY e 0�c:)
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Phone No:.(46-6) 2-Z J� `t �p Zip;b e- _ Fax
Phone No Fiji.in fee simple Titl&HO.lder on'next (-if different E Mail
from the Owner .Istel.above) State or County License
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If value of construction,is$2500".or more,a RECORDED'Notice. Commencement�s required.'
If.value of HVAC ifs$7;500 or more,aRECORDED.Notice of Comi�nencerrientIs 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 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 reviewyour 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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S+ ..I--VA G I COUNTY OF S�" •�ULG•(`P�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this f'q__day of MQktJ 20_ by this L�)_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 Identification Type,of Identification
Produced Produced .
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(Signature o (Signature .ublic-'SLi3N4�'€��)
�N1VP�s' '_ `'� Notary Public-State of Florida
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LU O'CONNOR ;�: Y
t • Notary °' Commission M GG 27ggdal)
Commission Y Public-State 6elal a Commission o o.
'•,,� ommission a GG 170518, Y omm.Expires Oct 23,2022
MY Comm.Expires Oct 23,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION "SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED
Rev.