HomeMy WebLinkAboutBuilding Permit ApplicationV 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� C� 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
Legal
Property Tax ID-#: 6
Site Plan Name:
Project Name:
Setbacks 'Front Back:
Right Side: Left Side:
Block No.
Aaaitionai-worK to De perrormea unaer tnis permit —cnecK an -Enat apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _Windows/Doors
)PElectric -P Plumbing _ Sprinklers _ Generator — Roof
Total Sq. Ft of Construction:
Cost of Construction: $ eld , sa
Na
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Nam
Com
City: State: /=/ AddressltdQ
Zip ode Fax: City:r p
Phone No. Zip Code:
E-Mail: Phone NoA
Fill in fee simple Title Holder an next page (if different E-Mail D Ali
from the Owner listed above) State or County
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN ENG EER: — Not Applicable
MORTGAGE COMPANY: - Not Applicable
Name•
Name:
Address:.
Address:
City State:
City: State:
Zipkj Phone
Zip: phone:
I
FEE SIMPLE TITLE HOLDER: _ 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 Coun makes no representation that is grantirg,a permit will authorize the ermit holder to build the subject structure
which is in coniict 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 tq your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first i spection. If you intend to obtain financing, consult with. lender or an attorney before
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SSinatyre�oOw ,�
ent/ Lessee/Contractor
Signature of Contractor/License Holder '
STATE OF FL I A
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STATE OF FLOI ►
COUNTY OF IO L�
-COUNTY OF
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The for oing instrum t was acknowledged before me
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The forgoing instru ent was acknowledged before me .
day 20�by.
this,M of
20 by
this of
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(Name of per
edging')
=meso edging )
(Si tune of N
ublicc--State of Florida)
jsi natu of No ary P lic-State of
Personally Known .
V OR Produced Identification —•
Personally Known OR Produced Identification
Type of Identification
�, Rebecca Dima
Type of Identification yru
Produced •e�, SHERRi FEHLMAN
Produced —
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fission GG060876
ission # GG 1060
Commission No.
- : EXplrp�e�inUary 9, 2021
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Commission No. °� . o� Ex S@bdi 14, 2022
Bonded BudgetNatwySetyl=
Bonded thru Aaron Notary
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