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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: � Permit Number:
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— - - ---- Building Permit Applicati0fV.'�P,r
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: e '0
PROPOSED IMPROVEMENT LOCATION:
Address: Y
Property Tax ID #: a ig 00 L4 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION 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:
lfo'stot-Constr-ucti0,n(�f� Utilities: _Sewer _Septic Building Height:
OWNER/LE=SSEE: CONTRACTOR:
Name Name:
Addre�ss':�5( 9 S. S - Company:
City: 1 - p � )°ArCPState-F-4 Address: - - _
Zip Code— Fax: City:,, State:_
Phone No. % Zip Code: _ Fazr2
E-Mail: Phone No
Fill in fee simple Title Holder on nex 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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7ress:
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Not Applicable
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MORTGAGE COMPANY:
Name:
Not Applicable
Address:
ne
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 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 wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder -
STATE OF
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FORIDA—t
COUNTY OSTATE
The fofp�ng instrume t was acknowledged before me
The forgoing instrument was acknowledged before me
this ayof20N::::)Ly
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 t �I
Type of Identification
Produced
Produced
(Signature of Notary Publi a of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ELLE — GHN
Commission No. (Seal)
State of. Florida -Notary Public
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