HomeMy WebLinkAboutBuilding Permit Applicationr-
All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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and Development Services . I r '� 1 i tf(1�8 ��:Building
and Code Regulation Division Commercial R'' , Gd111� r �L
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 0)kk 11 /c,-\ACb 3V6 o
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Project Name:
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Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 1)Uo Sq. Ft. of First Floor:
Cost of Construction: $ Q A41S �s 6 Utilities: —Sewer _Septic Building Height:
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Name:
Address:
Company:
Address:
City: 6+ State:
Zip Code: Y ? Fax:
City: State:
Phone No, " 230 �- T��
Zip Code: Fax:
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E-Mail: C� 3(Lkt' "1 zftI- Q" , C�. `•�
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
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 HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
MR
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-residentialuse
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie. County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Property Owner S gnature/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA_�A
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Svorn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
P ical PreseAce or Online Notarization
Physical Presence or Online Notarization
-
this % day of Vie 2 2020 by
this day of , 2020 by
or (tea m e .;r
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identify 'pn
Type of Identification
Produced I C
(IIA9
Produced
(Signature of"No y-Public- State of -Flo ida Cl
(Signature of Notary Public- State of Florida )
Commission No. :T:: AUDREYB. vl)REY
Commission No. (Seal)
MY COMMISSION # GG 300817
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.c •.a3 EXP ES91
Bonded
Thru Notary Pu'blic U
iderwriters
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REVIEWS
ISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20