HomeMy WebLinkAboutBuilding Permit ApplicationAll 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:
Address: Z Q
Property Tax ID#: 34o
Site Plan Name:
Project Name:
`V11.1 9.
Lot No._
Block No.
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 Const u�tion:
Cost of Construction $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
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Name �,�rire\\ C1^��GS
Name:
- -
Address: laoa 11.4VwaQA U.'t.
Company:
City: o-rc e 1- I State: r
Zip Code: 3k1G$D- Fax:
Phone No. _77,�- 032
Address:
City:
Zip Code:
Phone No
State:
Fax-
E-M : cV%t6&5 Q e�ovh
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 $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.
DESIGNER/ENGINEER: _ Not Applica
Name:
Address:
City: State: _
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY:.
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip.: —
Phone:
_;Not Applicable
Not Applicable
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 r6iew 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."
hignature
of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA t
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this V(_ day of C n- 20�by
this day of 20_ by--
r , (�
1 JCQ �l CAN W
Name of p rson making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced It
Produced
NX do
(Signature of Notary P lic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
Commission No. (Seal)
,o1pPY PVBn ELLEN VAUGHN
= o_State of Florida-
_ '=
mmission # 0
270079
REVIEWS
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fP4E!iV OR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19