HomeMy WebLinkAboutAPPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1 Permit Number:
Date:
* •
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: ) _
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric — Plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
Cost of Construction: $ L� Utilities: _Sewer _Septic
OWNER/LESSEE:
Namely Y r
Address:
City: C State:,:�
Zip Co Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Lot No.
Black No.
Windows/Doors
Roof Pitch
Building Height:
Name: \ `
Company: �- -
Addr ss: U 1
City:
State:
Zip Cod' .�J Fax:
Phone No t
E-Mail _C etlC ` CLAlt
State or County License 0 PC L
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 TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Cont or/ tense Bolder
Signature of Own r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA `
�1��\
STATE OF FLORIDA
y�\ �
COUNTY OF Y�J�
COUNTY OF
The forgoing instr men was acknowledged before me
The forgoing inst,km nt was acknowledged before me
this day of 20 by
this �cfay of Y` 20�by
Name of person making statement.
Name of person making statement.
Personally Known _\ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pr used
Produced
1
A 0%
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(Signature of Notary Pu i - e of is Ste* a{ Flex'4&
E Mercado
(Signature of Notary Public-
Y 11% rta!
anda
� Commission No. �Myc'S'G 139118
E> 0/202 t
Notary Public St7'e .Y %
Commission No, `F c, de
y sloe t;r, 1381 15
• Expires 08120/202
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.