HomeMy WebLinkAboutBuilding Permit Application A6 APPLICABLE INFO"MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I 2
E Date: Permit Number: a ® J '0���
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)452-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address:
Property Tax ID #: �3��3/060/�OG$" Lot No.
Site-Klan-Name:—. Block No.
Project Name:
,�/��.o ,�/ G✓ /so.
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank s Piping _Shutters
^Windows/Doors
,
_Electric Plumbing. Sprinklers. _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ aUU �"'� Utilities: _Sewer `Septic Building Height:
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Name Name.Company:!"iioG��:�'��G•f�
�.Address; .� 02. C;oe�r.✓,eo `.
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City. zCL State:/6G
ZipmCode :3�Q�� — � /ri ���'�.' �G
"Fax: -City:,�/O.e1� � State:
Phone No. Zip Code: 9!7�44-- Fax:
E-Mail Phone No t � 2n
Fill in fee simple Title Holder on next page ( if different E-Mail i
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. �0
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GNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applica ble
e: Name:
ess: 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 undeTgorng a ruli 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 YOU12 PAYING
TWICE FOR IMPROYEMENTS 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 Aily ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FL ORI .� STATE OF FLORiQA
COUNTY OF {�I COUNTY OFY�(Jr
The for ing instrument was acknowledged before me The�ffV,jffi�,.,ng instrum nt was acknowledge before me
t 's ay of 20A_ by U-I G�11'day of 204 by
y LA— "Wl A I
a of person kin eme Nam f person ma g st ent.
Per onally Known OR Produced Identification ers pally Kno n OR Produced Identification
T e of Identification of Identification
Produced Produced
(Si nature of Notary Public- BRYAN (Signature of Notary Public- a !& Jda )
JESS CAR. *_ MY COMMISSION#GG 2413 9
t;r Pus�c ION#GG 241369 _* c
Commission No. __`? = MYC �J� 0� Commission No. °;• Q� B(S�RES:Oryober19,20
*' PIRES:October 19,2 OF FL�• b ru Nota Public Unde e
Public UndeWri
l tefs
�•''F'••'�"`�' BondedThNNotary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
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