HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: rd`'9, Permit Number: _
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Building Permit Applicatian �, �O1i
Planning and Development Services coy ri5h
Building and Code Regulation Divisions Pit
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553. Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: c n i I
Property Tax ID#: pQ �+ 0 "I Q0q Lot No.
Site Plan Name: Block No.
Project Name:
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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:
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Cost of Construction$ Utilities: Sewer —Septic Building Height:
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Name` 2 /n S Name:
Address: 4/1n7 i— i�lJ1 q / Company:
City: ro State:FL Address:
Zip Code: 3y9f3,A_ Fax: City: State:
Phone No. -7`1a`:57 9 —70b0 Zip Code'. Fax:
E-Mail: �T7?Cxt�S 39/ O i�, (!.OM Phone No
Fill in fee simple 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.
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applica ble
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;186 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 9iv YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OFCOMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YO R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature wner/ Contractor as ent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA o STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this^day of 20_ by this_day of 20! by
Name of pers making slat t. V Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ��Imo Produced
(Signature of No Public-State lorida) (Signature of Notary Public-State of Florida )
Commission N `o Seal) Commission No. -(Seal)
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« My `ssion # °ta Y P
REVIEWS ° `idGG ybh ISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT- W REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19