HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Pt-rmit Number:
Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Property Tax ID 2-401-801-0098-000-2- Lot No. Iq
Site Plan Name; Block No, J0
Project Name-.
.P r
------ ----- -
Additional work to be performed under this permit -check all that apply:
—Mechanical Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing — Sprinklers Generator XRoct Pitch
total Sq. Ft of Construction-, --R1 op""— Sq. Ft. of First Floor:
J 0%
Cost of Construction: A-N�9 50 Utilities,, —Sewer _Septic Building Height:
Name—,
Address:
City-, - F,
r.
State: fl
Zip Code: 349 4 73 ... .. .... ... Fax:
Phone No. I'l 2-'940 - 3q/0 ... . .... . .
E,Ma& Co M
Fill in fee simple Title Holder on Vnep2igre"(if different
from the Owner listed above)
City:
Zip Code: q Fax:
Phone No
E -Mail -
State or County LicenseW.12,1-651-4—
.. ....... .........
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
It value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
E#J*1r41A
Name.
Address:,
City:
Zip;
Phone
State:
MORTGAGECOMPANY:
Name:
Address:
City:
Zip; Phone:
— Not Applicable
State:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: I 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 AsioIciation 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
""ARNING TO OWNEW YOUR FAILURE TO RECORD A NOTICE OF COWAIENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR VAPROVENIENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SM BEFORE THE FIRST IINSPECTKW IF YOU INTEND TO OBTAIN FINANCWC, CONSULT
_l TH YO"L]ENDER OR AN ATTORNEY BEFORE RECORDNG YPYR.NOTiC ,OF COMMENCEMENT."
of Owner/
STATE OF FLORIDA
COUNTY OlT
as,Agent for Owner
Signature 61 Contractor/License Holder
STATE OF FLORIDA
COUNTY 01`��,7_
The forgoing instrument was acknowledged before me The frgoing Instrument was acknowledged before me
2
this W day of 20by this A day of 0A.W
_IVP W _P by e
Name of person making statement Narne of person making statement-
Pt,r%onally Known A" OR Produced Identification i Personally Known OR Produced Identification
type of Identification Type of Identification
Produced,.Produced--
(T;a/ture f Notary P/ubI, Sta gnature Notary Pub&e"State of Fio
'a
W10RD '.r'y
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OMMISSION 4 GG26505
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co, m ion NO LJJ_W 055 r - sign Sol
*6CISSION 4 GG265(
EXPIRES ()ctuher 03, 2012
�oP9 EXPIRES October
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
C 4T VI W
OUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
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