HomeMy WebLinkAboutBuilding Permit Application 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 Residential
PERMIT TYPE :
PROPOSED IMPROVEMENT LOCATION :
Address :
Property Tax ID # : oc�l � 0600 Lot No .
Site Plan Name : Block No .
Project Name : aILO �l
DETAILED DESCRIPTION OF WORK :
CONSTRUCTION INFORMATION :
Additional work to be performed under this permit — check all that apply :
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq . Ft of Construction : Sq . Ft . of First Floor :
Cost of Construction : $ Utilities : _ Sewer _ Septic Building Height :
OWNER/ LESSEE : CONTRACTOR .
Name Name :
Address : Company :
City : P1, 12ka State : .LL Address :
Zip Code : n Fax : City : State : 15L•
Phone No . // �d Zip Code : N9 p� q 1 Fax :
E - Mail : i t6 . Ca /11 Phone No f7 as
Fill in fee simple Title Holder on next page ( if different E - Mail ' UR s*,s J41
from the Owner listed above) State or County License ,SC: ' �� � � /
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 : 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 INTENq TO B N FINANCING, CONSULT
WIT Ya R LEN ER-QR AN ATTORNEY BEFORE RECORDING YOUR NOTICE ENCEMENT."
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Signature of wn r ' 'ey ee/ cntra or as Agent for Owner Sis lature of ontractor/License Holder
ri
IDA STATE
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COUNTOY OFORICI ' 21(� -zf/� COUNTOY OF . Jl
The ping instrume was acknowledged before me The for ing instrumenWacknowl dg efore me
this`�("X 'day of this jday of 20by
Name of person making s ment . Nam e of pelson making stza ent .
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of IcI ntification
Produced Produce
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(Signature of Notar ub ic- St e of Floridallotblic Stairlonda
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Expires 01 /23/2022 r Tammy C Englist',
pf'p`sf Expires 01 /23/2022
REVIEWS FRONT ZONING SUPERVISOR 0+. CIE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev . 2/ 7/ 19