HomeMy WebLinkAboutBuilding permit application DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA r`1 STATE OF FLORID "I
COUNTY OF - .� COUNTY OF LLL(A P
The ffiptgoing instrument was acknowledge before me The fo[going instrument was acknowledged before me
this!V day of �( ��{ 2ppl�by this day of-7tt(t> _ 2Qtq.0hy
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification V Personally Known OR Produced Identification ✓
Type of Ide tification j( Type of Ide tification y t
Produced_--1OT`tdC,..O1,� Produced P/�}C`( C ►J L L.
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. .;A J, BOWEN
�.a'+A�,•� State of Florida Commission No.
Notary Public
SUSAN AWA
commissior a GG 323631
Notary Public-State of Florida
My Comm. xp res u
M Gomm.Expires 1 ;29.2023
REVIEWS "SRO PLANS VEGET TION OVE
COUNTER REVIEW REVIEW REVIEW REV I REVIEW REVIEW
DATE
RECEIVED
DATE
'COMPLETED
ev.41 IV
3'{
PRI T NAME
DATE
l
i
i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numbers
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
PERMIT TYPE:
P OAOSED IMPRt7 EM N TO L+ TIQN.
Address: V1 i c�
Property Tax ID#: 1 00 0 1 -L 1 oco 60 Lot No.
Site Plan Name:' ``" l T Block
No.
Project Name:X-��- —`
D TA LED Q R,IPTIQ R
VNA o
- 4 c ;!
s-li;- S I
3E
UCTIt3 INFQRM 0T11C}
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:$ a00 Utilities: —Sewer —Septic Building Height: 1
OUII;ME�R/LE��EE. Ct*�NT ,'C��T;;OR:
Name L. _'k Name:_,: �
Addrr+r--I;,_1.`(��; e c,3 a �,2 3 Crckc Company: ' Ct,rJ . '
City:_ - �" \��C B -IQ-\• State: Address: i1i l
Zip Code::qq 51 _ Fax: city: Stater
Phone No. Zip Code: Fax:7�776'q 9
E-Mail: Phone No !�
Fill in fee simple Title Holder on next page(if-different E-Mail 0 tS -YL40— 00+w\a " Ci)V✓N
from the Owner listed above) State C ount 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.
l i