HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number :
I I IT OFF
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone : ( 772 ) 4624553 Fax : ( 772 ) 4624578 Commercial Residential .
PERMIT TYPE :
PROPOSED IMPROVEMENT LOCATION :
Address : Z
Property Tax ID # : 6&w 01! W3 - A 0-0 02Lot No ,
Site Plan Name . Block No .
Project Name :
DETAILED DESCRIPTION OF WORK :
Moto
CONSTRUCTION INFORMATION ,
Additional work to be performed under this permit — check all that apply :
_Mechanical _ Gas Tank _ Gas Piping _ Shutters ZW ! ndows/Doors
— Electric _ Plumbing _ Sprinklers _ Generator ^ Roof Pitch
Total Sq . Ft of Construction : Sq . Ft . of First Floor :
Cost of Construction : $ Utilities : _ Sewer ^ Septic Building Height :
OWNER LESSEE , CONTRACTOR
Name !cl ff)at4vsnsoiAmsaoo a Name : R21AAP&IZ
Fss`Address : % � G Company :
City : ` ' u2 State : / Address
Zip Code : T7 Fax : City : V40LJ State :.EG .
Phone No . Jks3 q / 0 q 36 9 Zip Code : Fax :
E - Mail : �t,41 A q7 / �/�i f t d �. , � (9IV) Phone No • �j ,
Fill in fee simple Title Holder on next page ( if different E - Mail S
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 .
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION :
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 T BT I CING , CONSULT
WITH YOUR LFJODER OR AN ATT RNEY BEFORE RECORDING YOUR NOTICE C T."
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L/ Aps y
Signature of Owner/ Lessee/Contractor as Agent for Owner SignatootTContractor/ License Holder
STATE OF FLORID4. f STATE OF FLORIDA. /
COUNTY OF 1(�ldh l y n COUNTY OF _.Lr) tam !(/ m �
The Wd
g Instru nt w acknowledge before me The for oing instr en was acknowled ell before me
this ay of 206y this day of _ by
Name of person making st ent . Name of per on making statement .
Personally Known OR Produced Identification Personally Known 000e OR Produced Identification
Type of Identification Type of Id ntification
Produced Produced
(Signature of Notary P, I - State qrfl 'i a ) (Signature of t PP(14�e
c- Stat of Florida )
`?fib gym:=ter.%'• ;�s�'
Commission No . +�'" Notary Publi t of FloridNotary Public ,,tate Ida
'` � ry Commission N o ��(( �' 1nmy C C Cnglisf)
y Commis32 22 906987 My Commission GG 9069f37
ires REVIEWS ZONING SUPERVISOR PLANS VEGETATION EA R LE �K1ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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