HomeMy WebLinkAboutBuilding Permit ApplicationAllAPPLICABLINFO MUST B,F COl_. ETED FOR APPLICATION TO BE ACCEPTED S
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-- --- Building Permit Application
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Planning and Development Services
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Building and Cade Regulation Division
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMIT TYPE: Ord
PROPOSED IMPROUEMIIEJJNT LOCATION:
Address: Z�J
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Property Tax ID #: a-;� ` l CJ) oon4 — ` o y
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DE-SGRIPTION OF WORK:
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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: Sq. Ft. of First Floor:
Cost of Constructions §10?50;Z)OD . 0 Utilities: —Sewer —Septic Building
Height: .
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: Company:
city.to — I State: _ Address:
Zip Code. Fax: City:
State:_
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Phone No�,l7 �%[il� ^ 1�wii Zip Code: Fax:
E-Mail: �YYI Phone No
Fill in fee simple Title Holder on next age ( if different E-Mail
from the Owner listed above) 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.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT"
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Signature of Owcr/ Lessee/Contractor as Agent ner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20 by
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 Identification
Type of Identification '
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
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
Hev. 21 i/ 19
t
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 AFFIDAVIT: Application is hereby made to obtain a permitto 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature ofOwner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID / STATE OF FLORIDA
COUNTY OF L1 COUNTY OF
The fgj��'Ing instrume t was acknowledged before me The forgoing instrument was acknowledged before'me
1 2G_qy this _ day of . 20_ by
f—�,
this ay onfCY
,
LJC�� I I—2 Ck l
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 r r Produced
(Signature of Notary Publi a of Florida) (Signature of Notary Public- State of Florida )
Commission No. ."".d'O ELL Commission No. (Seal)
a. =_State of Florida-Noary Public
y Commission N GG
.y1""01 Ommissior Expires
REVIEWS 22 OR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER EVIEW R REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
r
DATE
COMPLETED
ev.