HomeMy WebLinkAboutBuilding Permit Application All APPLICA E I T�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 V/
PERMIT TYPE:cpn n�)cc� LM IT
PROPOSED IMPROVEMENT LOCATION:
Address: 01 —
Property Tax ID#: 1 I • l • 44 t )D • Lot No.
Site Plan Name: p� Block No.
Project Name: Dr t _�_(L�
DETAILED DESCRIPTION OF WORK:
i
CONSTRUCTION INFORMATION:
Additi nal 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: $ 1 Utilities: _Sewer _Septic Building Height:
OWNER LESSEE: CONTRACT R:
Name, /k1f1 b1e�_ _b ID I Name:_
Address: L c:7 251 Company- •
City StateFL— Addres
Zip Code: "Fax: City: State:
Phone No. D Zip Code: �—
E-Mail:nl Phone No
Fill in fee s mple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
MATz �x �4�ilisr 7
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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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si re a Owner/ sseeftontractor as Agent for Owner Signat rg Contractor/License" older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF --� �9 COUNTY
Th g ing ins t wledg efore me The g ng ins "itr(NITwled e efore me
this&ay of 201�by this of 20�i by
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Name f person ma ing statement. Name of person ma ing atement.
Personally Known �// OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Type of Identification
Produced P ced
(signature o y I'c to �StOWotI:W (Signature r o
publ C(U�Bd� H��o88
Commission No. 1@��HA00 commission
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REVIEWS FRON ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED