HomeMy WebLinkAboutPERMIT APPLICATION'�PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Permit Number:
vale:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Residential
2300 Virginia Avenue, Fort Pierce FL 3 Commercial ____-____
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: P I �"h (
PROPOSED IMPROVEMENT LOCATIO
Address: � tC1 Lot No..
_ �., 1 }� � � .`
Property Tax ID #:
�� Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
i
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply: Windows/Doors
Mechanical _Gas Tank —Gas Piping Shutters
Plumbing _ Sprinklers _ Generator
Roof _. Pitch
Electric —
Total Sq. Ft of Construction:
Cost of Construction: $ �
OWNER/LESSEE:
Name C-7 'OC Q
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Add rs: t, C
St
City:
Zip Code:__— Fax:
Phone No.—
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: (T-h
Company: l !
Address:
City
Zip Code: '
Phone -N-oo
E-Mail__
State or County Lice
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requited.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
Building Height: ___
M
Fax:
it
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 Owner/ Lessee/Contractor as Agent f r Owner
Signature of Contractor/License older
STATE OF FLORIDAL1-
STATE OF FLORID
+ COUNTY OF '
COUNTY OF c
The forgoing instrumentmas acknowled ed before me
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The forgoing instrument as acknowledged efore me
_day V- by
this day of 20 by
this of - 20_
Name of person making statement.
Name of person making statement.
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of ary Publi State of Florida
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Rev. 2/7/19