HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 Permit Number:
An
Building Permit Application
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: [ (, i' } 1
Property Tax ID #: —
Site Plan Name:
Project Name:
j DETAILED DESCRIPTION OF WORK:
r7"TAWa 1
Residential_
Lot No._
Block No.
j CONSTRUCTION INFORMATION: —I
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 I Pitch
Total Sq. Ft of Construction: i o / Sq. Ft. of First Floor:
Cost of Construction: $ 22,0 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
i
Addres :
,
Company:
j,
City: 6 h ffll�State:
Zip Code:, ' Fax:
Phone No. zb b
Address:
City: �{
Zip Code:
Phone No
i
Fax:
13� 4
Stater®
_.
E-Mail: C
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above
E-Mail 1� I
State or County License
- ---------------- -- r---- •,. ••••,• •,, •• ••�........�.,. w1 �v %P a.vnunen(:ement Is requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 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 j6f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License 14older
STATE OF FLORIDA i
COUNTY OF (
STATE OF FLORID p
COUNTY OF C' i
The ing instru nt s knowledge�%Yore me
is day of .20 � y
The r oing instrum nt was cknowledg ore me
thi ay of 20 y
iI n t:A% h ��1 fmil�]
IF*
e of erson atement.
ak70R
m to �ent.
Nae of person maki7OR
l
Personally Known Produced Identification
Type of Identification
Produced
Personally Known Produced Identification
Type of Identification
Produced
ry Pubtic- State of Flinn a = 4
atu a KAiNEhINE H�Vb
_ IV1Y COMMISSI
CI COMMISSION G1
ommission No. F " �e EXPIRES DEC 04, 20
���ded through,
U0h 1st State ins,ra
ce �--
5 ,,
1
�.
r ic- Stag of Fj9,;7Jda KATHERINE HAVEf1S
°
�- MY COMMISSION #GG1650
Commission No. RI ,43ea1j=XPIRES. DEC04, 2021
F �...
Bonded through 1 st State Insura
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 1