HomeMy WebLinkAboutBuilding Permit Application All APPLICA E 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:
(5yv&w Ono
Address: `1 7
Property Tax ID #: 7Lo 1 Le- I (9 ' 'o6 � 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: o v U��� Sq. Ft. of First Floor:
Cost of Construction: $ SQL U� Utilities: _Sewer _Septic Building Height:
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Name _'' Name:
Address: W
W_2
J t54, a V I Company:
City: State:_ I Address.
Zip Code: 3t % s Fax: City: State:
Phone No. 7 ;� Zip Code: Fax:
E-Mail: X&) 1YI7 Phone No
Fill in fee simple Title Hoider on next page( if differdnt 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,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 IMP O ENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON T E O -SITE BEFORE IE FI T INSPE�ION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR N EId OR" TT EY.,B ORE R ®RDING YOUR NOTICE OF COMMENCEMENT."
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Signatur f ri //%/
e/ ont ctor a Agent for caner Signature of Contractor/License Holder
STATE OF FLORID STATE OF �OR1DA
COUNTY '
COUNTY OF vl�c.i
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of /ate-( C 20�J2 by this,day of 20_ by
Name of person m king statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ��? s Produced
(Signature of Notary Public-State of Urida) (Signature of Notary Public-State of Florida )
Commission No. "" i,, Commission No. (Seal)
=a ;estate of VAlip—
v411,
a Via,: rvi! a,No
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REVIEWS COUNTER 4 R LI G der �ll�lres he VIEW LANSVREVIEWON SREVIEEA WLE MANGROVE
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19