HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ff
Date: "�. /77, 2-D) Permit Number:
RECEIVED
Building Permit Application
FEB 1 ?.D1
Planning and Development Services Permitting U�iac�Ftr�?er,
Building and Code Regulation Division St. Lucie COU67,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PRQPOSEE?�NPR�?VEMENEE�CTtt?t�
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
P_
Lot No. /0 5r
Block No.
£ai�STRU€:TiO
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: $ L9 V Utilities: _ Sewer _ Septic
Windows/Doors
-Roof Pitch
Building Height:
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Name:
Address: /4 �S� S Dc ee�n lJ'! • t��d s
Company:
City:State: ��
Zip Code: 3`¢9S� Fax:
Phone No. 10 � % - ,0
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: MS .Co�� �L e VAAD.6AM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 52500 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.
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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
wnru yrne n a rNmrio raw AN ATTORNEY RFFnRF RFCnRDING YOUR NOTICE OF COMMENCEMENT."
Signatur f Ow er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ISTATE
OF FLORIDA
COUNTY OFLe�c�_COUNTY
OF
The f r oing instrume t was acknowledged before me
b
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of_�0�
m , �-
Name of person making statement.
Name of person making statement.
Personally own OR Produced Identification '�
Personally Known OR Produced Identification
Type of Id nti i ation
` L
Type of Identification
Produced
Produced
(Signature of Wary Pu — (Signature of Notary Public -State of Florida )
•PYP(j •• AUDREY B. HUMPHP.EI'
Commission No. = c :,; MY�gy1SSI0N#GG3G0817 I,1ommission No. (Seal)
6, 20^3
Q` EXPIR S: March
•OFFS. Bonded Thru Notary Pub:!. Oode.wr t I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z///1y