HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: gcfW01 4i .';4
Address: �G�CY
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Property Tax ID #:
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Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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Lot No.
Block No.
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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. Ftp of Construction: p�d G Sq. Ft. of First Floor:
<Cost of'Construction: $ Utilities: ksewer _ Septic Building Height: F I f
OWNER/LESSEE:
CONTRACTOR:
Name " d- e ArA 13tvn0' 001CLv
Name: a
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Address: '' 9 !'eC�a/I ff, I
Company: ,In �� lJ� JG��- //1C
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City: E'v�= ✓� " �
Zip Code: 3 955-7 -Fax:
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City: ,,,1e/1 ,f
Zip Code:` /I7 Fax:
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Phone-No�2.2
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Fill in fee simple Title Holder on next page ( if different
State or County License
from the Owner listed above)
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If value of construction is 5z5uu or more, a nCtVRVCV UL — v. •- - --- --
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENIRNEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not a
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Phone:
BONDING COMPANY:
Flame:
Addi
City:
Zip:
hone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the wo
I certify that no work or installation has commenced prior to the issuance of a permit.
-Wo—t Applicable
State:
.Not Applicable
installation as indicated.
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 JO�kjSITE BEFORE T� FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCI G, CONSULT
WITH YOURJe�IDER OR AN AL hNE--Y BEFORE RECORDING YOUR NOTICE QfJ.OMMENCEMENT'_
ev. 2/7/19
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatu rkeftonrractor/LicenseHolderr
STATE OF FLO I '
STATE OF FLORIF��_A
COUNTY OF
COUNTY OF
The forgoing nstrum was acknowledgeefore me
this day of 20 by
The forgoing instr me t was acknowled efore me
this day of 20by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification \�
Personally Known OR Produced Id(,ntificati
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Type of I of ca '
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Type o ti 'cation
Produce rL
Produca
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(Signature of Notary Public- State f Florida )�nly� J l
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DATE
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DATE
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ev. 2/7/19