HomeMy WebLinkAboutBuilding Permit Application Mar 08 21,09:36p p 1
All APPLICABLE'iNFO MUST,BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Permit Number: � �� �� 5L d
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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:
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Property Tax ID#: 3�'�q~ 1 — � ��(� Lot No.
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Site Plan Name: Block No.
Project Name- j
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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:$ �4- Utilities: ^Sewer _Septic Building Height:
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Name Name.
Address: O- Company: c
City:( U G State: Address:
-Zip Code: fi Fax: City:0f9 1 b _ State: 1
Phone No. Zip Code: 2� pr`i 3 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different 1 E-Ma(( � -- )-) ana
'from the Owner listed above) State or Gountyl_�cense
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,800 or more,a RECORDED Notice of Commencement is required.
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Mar 08 21,09:37p p•2
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State: 1 i
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: I I
City- city: I I
Zip: Phone: Zip: Phone: 1
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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 exemptfrom undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another non-residential use
wWARNING::.:TO OWNER: YOUR FAILURE TO RECRRD A NOTICE''. .. F
CO R VNCEM,ErNT yMAY. RRRESULT ! YOUR P , N TWICE ]F R
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E% T DO OSTEaPE N TH ENOJOBE ITE OMM NEE ENTM
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IN PECT[ON. IF OUU I END TO BT FINANT
S�EENDEERR p� l A AT�ORNEY B ORINN,�&ONSULT WI H YO{�RMMEN EMIAN EF E RECOOR YUR NOTICE OF
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Signature o wner/ essee/Contractor as Agent for Owner Signature of o/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF ST \_Q C11?
The for Ding instrume ty knowledged before me The forgoing instrument was acknowledged before me
this day of Nl� 20a by this�day of VAM,011 202J, by
Name of person Making statement Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification x
Type of Identification Type of Iden on
Produced Produced - L
` 'P. •'s�e�JE.Yr,-,_•. '�%. � ,..,���yl�lllrrrt�
(Signature of Notary P u&is-St$fe of ti �o?,� (Signature of Notary PuRc-5 ate of
Commission No. -� ( ,;� o`er Commission Noksl•�AZ��j� W V�g �a�ti7'2o� �' 41
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REVIEWS FRONT ,4 a�.�*RVISOR PLANS VEGETATION SEA*,J 4MA"
COUNTER REV(t lll�ss,4'%%i EVIEW REVIEW REVIEW RE�i T '=J:ti'�n.+{ V[ y
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RECEIVED
DATE
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