HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST B/p��COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "7 —wb Permit Numbe
IN I Building Permit Applic tion AUG a ��20
Planning and Development Services PeL
:L,,-;,l �,Y..:�S' itiliPlt
Building and Code Regulation Division Iml C! �r� (� L
2300 Virginia Avenue, Fort Pierce FL 34982 y'r FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address: sing
" O W ff gg``�� 10"
Property Tax lD #: l q — 7o 16
Lot No. 2
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: ��77 �✓ Sq. Ft. of First Floor:
Cost of Construction: $ p C)e• 06 Utilities: —Sewer _Septic Building Height:
OWNER/!"E�SSEE:
CNTRACTOR:
Name rM W ipOr Mefyq
Name: f4
Address: A I
Company: i/ c,
A] s
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City o State
Zip Code• ;� � � Fax: ,
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Fill in fee simple Title Holder on next page ( if diffe nisi'
from the Owner listed above)
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.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
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 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 NO ICE OF COMMENCEMENT."'
Signature of ee/Contractor as Agent for Owner
Sig atur of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 5�,Zct.c-1e—
STATE OF FLORIDA
COUNTY OF 2A wAA—D
The for oing instru nt was acknowledged before me
this day of 2026:6y
The forgoing instrument was acknowledged before me
this L day of —3win 12030 by
ilea6 rn01(_56L
-If_ve �r' on'o-� �
Name of perso aking statement.
Name of pers0A making statement.
Personally Known ✓ OR Produced Identification
Personally Known �. OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida•)
(Signature of Notary Public- State of Florida)
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Commission Nc&G 05 e f�Seal
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