HomeMy WebLinkAboutBuilding Permit ApplicationAI I APPLICABLE INFO MUST BE
)ate:
PLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
,71anning and Development Services
3uilding and code Regulation Division
.r300 Virginia Avenue, Fort Pierce FL 452 157$
?hone: (772) 462-1553 Fax: (77 )
s?ERW TYPE:
4
/,ddress:
I"OpertyTax 0
C:te Plan Name:
Project dame: f�
do -
Building Permit Application
Commercial __ . Residential Y�
JD
------------
Lot No._Y—
Block No. _
Additional work to be performed
under this permit
— check all that a�hutters
+ /Wlndows/boors
Mechanical Gas
Tank
--k Gas Piping
Pitch
—
Plumbing
Sprinklers Generator
Roof �—
Electric _
1
Sq. Ft. of First Fioor:
Total Sq. Ft of Construction:
Se tic
P
Building Height:—
-
Cost of Construction:
s��
Utilities: � Sewer �
,
:.I _w- -,: r-.._. Name: .la
_ h ;Company: e
Address: r ✓ i-
Y Stater State.
Address:
City: `.,
�p City.
Zip Code: `� F 3V Fax:
Zip Code:
Phone No. phone No (-77�
E-Mail: t �
er on next page (if different
Fill in fee simple Title Hold
Mail .
� from the owner listed above)
I State or Cou License
ice of Commence,"
ff value of cons#ruction is �25mute,
0 a e a RECORDEDCORDED NoticeoftCommen Commencement is required, required.
if value of l#1/AC is $7,500 ,
MOW
_ I
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: Phan
_
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to dc
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
which is in conflict with any applicable home Owners Association rules, bylaws or and covena
to build the subject structure
its that may restrict or prohibit sucr
structure. Please consult with your Home Owners Association and review your deed for any r
strrctions which may apply.
fn consideration of the granting of this requested permit, f do hereby agree that I will, in all re
pests, 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 rev
ew: 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 PAYI'IG
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED A'ID
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND)
TO OBTAIN FINANCING, CONSLI-T
YOUR LENDER OR AN ATTORNEY BEFORE RECORJDING>GUR NOTICE OF
COMMENCEMENT-"
i{I
Sign ure of Owre Less e/Contractor as Agent for Owner
Sign ure of Contractor/Lie
e Holder
STATE OF FLORID/ RID
STATE OF FLORiD�
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The for aing instrument
s nowledged before me
this � day of 20� ly
this ay of
ZO4by
N h
A� t
Name of person making statement. U
Name of person making s
atement.
Personally Known OR Produced Identification
Personally Known
OR Produced Identification _
Type of Identificatio
Type of Identification
Produced � �
Produced
r�
(inay}
tary Public-
State o Florida
_
ftYA��KP
E LEN V
o,P gel` s AUGHN
tat& of Florida
YP
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C Notary Publi al) _
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(Seal)
9F P�4- 70079
MYQ ammission Exprr�s
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REVIEWS
FRONT
ZONIN
SUPERVISOR
PLANS
z
SE TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
I REVIEW
VIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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