HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U Permit Number:
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 Residential
PERMITTYPE:
I PROPOSED IMPROVEMENT LOCATION:
Address: �9v&
Property Tax ID #:
Site Plan Name: _
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Lot No.
Block No. 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 Pitch
Total Sq. Ft of Construction: rl Sq. Ft. of First Floor: d ��
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company:
II
City: [._. State: _
Zip Code: ?-� 4f —Z Fax:
Phone No.-49T) ( h131 / . Jc'
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail:
'sS
Fill in fee simple Title Ho er on next page ( if different
from the Owner listed above)
E-Mail
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.
FLORIDA INDIVIDUAL ACKNOWLEDGMENT
F.S. 117.05(13) — Effective January 1, 2020
State of Florida
County of R L&o—�' I
BEVERLEY DOUGLAS
o61,111, Notary Public. State of Florida
CommissionN GG 38793
My comm. expwss Od. 22. 2020
Place Notary Seal Stamp Above
The foregoing instrument was acknowledged before
me by means of
® Physical Presence,
—OR—
❑ Online Notarization,
this day of �"�, by
ate Month Year
2
Name of Person Ack wledging
Y", '�4'4 -
Sign�ature o/f �io�tory Public — Stateof Florida
/
Name of Notary Typed, Printed or Stamped
❑ Personally known
6?'P-roduced Identification j' r
Type of Identification Produced: ►�LIV� "��'
Vr 1 wI VF1L
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: "r i4 I
Document Date:
Signer(s) Other Than Named Above: I
02019 National Notary Association
P2, t-),.� Nip ( zl,y-\
Number of Pages:
Z
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not A e
Name:
MORTGAGE COMPANY: _ N icable
Name:
Address:
City: Sta e:
Zip: Phone
A r ss:
Ci State:
Phone:
FEE SIMPLE TITLE HOLDER: _ N plic
Name:
O ING COMPANY: Not Applicable
Name:
Address:
Addres .
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."
22
2��
Signature o Ow er/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY
The forgoing instrument was acknowledged before me
this 4g� day of r'L (_ 204D by
Name of person making staterner1l.
Personally Known OR Produced Identification _L
Type of Identification ,,,, Q
Produced �a1-1.- �,r U�` UC0 r_"•—k
re of NotaryPublic-
Commission No.dt
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
BEVERLEY DOUGLA
naTY�611C"9la►e-atI ride
Commission#5 �'382 0 S
FRv comm. expi
e of Notary Public- State of Florida )
on No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19