HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �V
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Date: 1 I� 30, 2-0� I Permit Number:
� R o 11011
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Building Permit Application �rt�e"`
p�S�Ci����� i� aarm
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL34982 Residential
(772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
Address:
Property Tax ID #:
Site Plan Name: _
3 d L}'U D 3-o o o
Additional work to be performed under this permit- check all that apply:
chanical — Gas Tank — Gas Piping —Shutters
V_ Electric _ Plumbing — Sprinklers — Generator
Total Sq. Ft of Construction: \;Z Ll 0) Sq. Ft. of First Floor: _
Cost of Construction: $ V U� Utilities: _Sewer _Septic
v
r
Lot No.,
Block No.
Windows/Doors
w
Roof
Piton
s n"
Building Height:
Name Z'"� a-T ra II10-I?S�'�
Name:
I ✓I v
Address:�tsLl
ompany:
State j��
Address:
City: / I
3 U Fax: � i 93
City:
Zip Code:
-1 �- l ��
Zip Code:
Phone N
I I �i" zy�
E-Mail:
Phone No
Fill°in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above) {
State or County License_
RECORDED Notice of Commencement is required.
If value o const ction is $2500 or more, a
RECORDED Notice of Commencement
is required.
If value of HVA is $7,500 or more, a
State'.
Fax: "`
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
swhich tructurin e. Please consult w with applicable
lome Owners Association and rules, bylaws
or
or any and restrictionsnts hat which may arestrict or pply.
such
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 13E 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."
Signature wner/ Lessee/Con tr a Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C k� _ COUNTY OF
The forgAing instrowledgedVefore me
this ay of 20 by
o A Name of person making statement.
J �j
y� o Personally Known OR Produced Identification
0 C Ty f Identificati n
cc
W y y Pr duc
O
vv
�,; ., (Sig re of Notary Public- S ate of Florida )
Vol
e k;Commission No. (Seal)
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this _ day of , 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW
SEA TURTLE I MANGROVE
REVIEW REVIEW