HomeMy WebLinkAboutBuilding Permit App All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
V� iioyY eoAl� �..,!A'��r�j�'tlr€dS�
Agriculture Exempt Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
----- --- - - — - -
PROPOSED IMPROVEMENT LOCATION:
Address: i i✓�. �� ���� `► rt:w a �«�=e
Property Tax ID#: 2203 -- 22 I — 0001 —1000-S Lot No.
Project Name: ( e+0
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Utilities: _Sewer —Septic Sq. Ft. of First Floor:
Cost of Construction: $ Total Sq. Ft of Construction:
FLOOD LAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
t
floodplain: :
k
Nonresidential Farm Building: Temp. Bldg./Shed used exclusively for construction : __..__
Mobile/Modular for temp, construction office: Bldg. involved in distrib. of electricity:
Other: _ Flood Zone: •' BFE: Floodway? Y/N If Y,
No Rise Certificate with supporting data attached? YIN
i
All other applicable state and federal permits shall be obtained prier to commencement of
construction.
OWNER/LESSEE: CONTRACTOR:
Name k i ��F Name:
Address: c Company:
City: e- State:V7i . Address:
Zip Code:&A-PL\CJ Fax: City: State:
Phone No. n2 4 __7 21 L4 Zip Code: Fax:
E-Mail: 'Cl , cum 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 HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not A licable
— pp 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."
Sign ture of Own Lessee/Contrac or as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Cl day of Q11.&rn0(;f , 202u by this day of . 20_ by
Mrl C.-UYlatw
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
Produced Produced
CA
(Signature of Notary Public-St e 1qn _-T-5-IThature of Notary Public-State of Florida)
CIE E.MASON
}} Co fission#GG 157934
Commission No P� of \ym''sNovember6,2021 Co ission No. (Seal)
°F°,`.•' Bonded fire Troy Fain Insurance 800 s-7o19
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/2019