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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� _
Date: Permit Number:
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
PERMIT TYPE:
D:IMPROVEM;ENT LOCATION
Address:'
Property Tax ID #:
Site Plan Name:
Project Name: _
)MILED DESCRIPTION' OF. WORK
Residential ,,-
CONSTRUCTION'INFORMATION:
Additional work to be performed under this permit -check all that apply:
✓/Mechanical _ Gas Tank _ Gas Piping _ Shutters
J Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ `\ciJQ) Utilities: —Sewer —Septic
Lot No. �e6�
Block No.
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE
CONTRACTOR '
Name
Name:
Address: oS
Company:
CityStateNL
Address:
Zip Code:7k�,j� Fax:
City: State:
Phone No.
Zip Code: 7 yQ 'A kc�, Fax:
E-Mail:
Phone Noel)
Fill in fee simple Title Holder on next page (if different
E-Mair\Cw Cs -
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:
e.S
_
Name:
Address:
r
Address:
City:
at•' State:
City: State:^
Zip: 3L\hT1one
-
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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 onflfct with and[ pplicable Home Owners Association rules, bylaws r and covenants that may re trict or prohibit such
structure. Pease consult wyit�i your Home Owners Association and review your geed for any restrictions whic 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 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 attornev before commencina work or recordine vour Notice of Commencement.
ature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Con c or/Ucense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF-�-
Swor o (or affirmed) and subscribed before me of
Swop to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
✓ Physical Presence or Online Notarization
this day of 'lJ--�-J . 2020 by
this � day of N O > . 2020 by
Name of person making statement.
Name of person making statement.
Personally Known L/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary P li '�� a of FlorWat)_A M HUNTER
of FloftftLy M HUNTER
(Signature of NoTBonded
�'- Notary Public - State of Florida
?°; Notary Public • State of Florida
,a .. Y
Comr� N GG 2810625tt
Commission No. ComNores Jan 23, 2023
c`-Com GG 281062
Commission No. ` �'�.
IMy
through National Notary Assn.
My Com xpi es Jan 23, 2023
Bonded through National Notary Assn.
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