HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 -a.) — % � Permit Number: 1 A
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- Building Permit Applicatio
County, Permitting
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: ((�� a�1iYt�r
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PROPOS -0 IMPRO MENT LOCATIO
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Address: ����r;LC�C �� � b r6yi 12 . err g
Property Tax ID#: �'�a.'�� bOlr 660u�-6m-1
Lot No.
Site Plan Name:
Block No.
Project Name:
DETA LED DE=SCRIPTION O WORK:
Yi i h �� �'Y1CP G q!� [P
SPl(' j_ n el
TR 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 Construction: $ Utilities: —Sewer _Septic Building
Height:
a ILKWITIRAUQ013M
Name Name:
Addre eX& K Company:
City: -J Jjg j p i-cic�e State:£ Address:
Zip Code: 3 Y4'0 Fax: City:
State:_
Phone No. ��� �i 3 f 4Oa � Zip Code:
Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( 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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: I Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:_
Address:
City: I
Zip: Phone: Zip:
OWNER/ CONTRACTOR AFFIDAVIT: Application is hereby made to obtain a permitto do the work and installation as moicated.
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'Associatioh 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
wRu,Yrn io r Feinim nD AN AT-rnDNFY RFFORF RE[nRnING YOUR NOTICE OF COMMENCEMENT."
41gnattWe Ovi er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF 5k_
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of —1 a r 20 3A by
this _ day of 20_ by
`-<`e
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 rF�-H01)ftAf 5
Produced
(Signature of Notary lic- State of Flor'
(Signature of Notary Public -,State of Florida )
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Commission NoGC,A� "b"t4•M'', �($e M1,A55M10
I� ommission No. (Seal)
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FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
COMPLETED
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