HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE C011n"ll FOR APPLICATION TO BE ACCEPTED�r�
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Date: Permit Number:
Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Additional work to be performed underthis permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric Plumbing _ Generator _ Roof Pitch
_ _ _.Sprinklers
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�'� 3� ✓�I d Sq. Ft. of First Floor:
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;Cost of Construction: $ I j Utilities: —Sewer —Septic Building Height:
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01NIV`ER�LES'SE�E�""C
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TRACTOR.���,
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,!'Name
Name:
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Z4t ' �t-� �`"� Company:
��Address:
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City: State:AL Address:
Zip Code: -e-;?�Qq. Fax: City: State:
Phone No. C3 Zip Code: Fax:
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E-Mail: %' 1/1�1%' j--0 60A Phone No
Fill in fee simple Title older on n f different E-Mail
from the Owner listed above) Qyr3� 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.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'- -
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Date: Permit Number:
91r.
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17,_. I.M. -:.,°` Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772).462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Pro ert Tax ID #: �b1 Lot No.
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site Plan Name: Block No.
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
_ _
taf gF�tofonstrlictioy . Sq. Ft. of First Floor:
Z,Cost of Construction: $ % 5(:�'i UDC Bc Utilities: —Sewer —Septic _ Building Height:
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�OWNE3R LESSEE xa� �s ,mur CONTRACT �3 R p' ,� 'tkra_W x.
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°NameG�yt�i tr'/' Name:
Address: Z?t ��5 s'�o r� Company:
I City: �Pil2�Aie" /a4J, `�f' State:,—*& Address:
j Zip Code: '� U�I Fax: City: State:
Phone No. 73o5r — Zip Code: Fax:
/I..
E-Mail: � W i/✓!"1r , T GGi� Phone No
Fill in fee simple Title older 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.
n
SIUIP P'L yll/llNAL <;R3UC I' N IIE�N�Ii`/ lI "F�
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DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
. MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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:Ahe 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 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
:+t. I ..,.4 ,� �++.,rno i hcfr%ra_Pmmmanrina,Ainrk nr rprnrding vour Notice of Commencement.
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JLA �✓�W /
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nature Owner/ Lessee ontra or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �1 /LQ���
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this _ day of 120201by
2`0220
this day of 12020 by
i 1 , ^-0
Name of person making statement. U
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification x;,
Type of Identification
Type of Identification
Produced ,
Produced
F L)
(Signature of Notary Public- State of FELLEN
A re o Notary Public- State of Florida )
�IIY PI
��o1State of Florid
Commission No. a Commission
-Notary Public
(Seal)
My Commis
ion Expires
r
�11 I111` �1L`LL
2 22
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ZONING
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MANGROVE
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Rev. 5/b%11JI