HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUS B CE OMPLETED FOR APPLICATION TO BE ACCEPTED' Date: `O
�� 21 Permit Number: M
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78
PERMIT TYPE:
Address:
Property Tax ID #:
Site Plan Name:
Building Permit Application
Commercial Residential
C�5- n0�1
Lot No.
Block No.
Additional work to be performed under this permit - check all that apply:
Mechanical — Gas Tank — Gas Piping —Shutters
Windows/Doors
— Pitch
Electric — Plumbing — Sprinklers — Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
__'=" Utilities: Sewer Septic
Cost of ConIt,-- $� =g�iU — —
Name:
dress:l713� el Me t9r Company:
y: T P1 Qirce State: I Address:
p Code: 'Wf E.2 Fax: City:
one No. -7-? z - Zip Code:
Mail: G #5oA/X2711 12 Phone No
-
I in fee simple Title Voider on next'page ( if different E-Mail
am 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.
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Building Height:
Fax:
State:
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DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Ph
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City
Zip: Phone:_
_Not Applicable MORTGAGE COMPANY: _ Not Applica ble
Name:
State
Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 013TAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ignature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA KN
COUNTY OF
The oing ins me t was acknowledged before me
this day of , 20_7-i by
Name of person making statement. -
Personally Known OR Produced Identification
Type of Identificadq�
Produced (" L b L-�-
(Signature of Notary Pu tate of Florida )
Cc
DATE
RECEIVED
DATE
COMPLETED
ev.
Signature 'of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
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)
ELLEN VAUGHN
State of Florida -Notary Public
ion 270079
Fydml `fV SUPERVISOR PLANS I VEGETATION SEATURTLE. MANGROVE
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