HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division j
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: 110 f6e—n� r t RQ �1/[ t�'� �-pC _ V1 . T qs-)
Property Tax ID#: ,6-d -cc) 7%—000 Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to he performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors
Flectric — Plumbing _ Sprinklers i Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (�0611
Sq. Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
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Zip Code: � Fax:
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Fill in fee simple Title Holder on next page [ if different
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from the Owner listed above)
State or County License- 0S—tK0to
it vaiue or construction is �,tsuu or more, a KtGUKULD Notice of Commencement is required.
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:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFIFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated_
l 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 Horne 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, f 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 IMPROYIEMENTS 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 COMMENCEMENI
Signature of Owner/ Lessee/Contractor as Agent fbr)owner i Signature of Contractor/License Folder
STATE OF FLORIDSTATE OF FLORIDA
COUNTY OF {, COUNTY OF 3
The forgoing inst ument'wa acknowledged before me The forgoing instrument wagknowledged before me
thisl'�`cc� day of ' �} � 20";)Gby this da of r"° f '
Y t {'] ) , 2Q,by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification/
Produced
VAkf",rqym�
(Signature ary Pu - ,�,9, i� WRIEG[ESY-VARNEY
wy,Notary Public -State ofFlorida
Commission No. _'s t�a'j).ion#GG 099801
MY Comm. Expires May 1, 202cF E
Bended thrxeh Naiianal Notary Assn.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Name of person making statement.
Personally Known \_ f OR Produced identification
Type of Identification
Produced
(Signature oUbt+ ary Puljic- to 9f' iclikRLEYMARIE GiESY-VARNEY
$*, Notary Public: -State of Florida
Commission No.' I issIon#GG 099801
9 Q; y n m. Expires May 1, 2021
"'.; FoF sed```,•:
bonded through National Notary Assn,
SUPERVISORPLANS I VEGETATION � IIREVIEW
ET EWE I MREV ROVE
REVIEW REVIEW REVIEW