HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CO PLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
late:
Building Permit Application
"tanning and Development5ervices
1�uilding and Code Regulation Divisio
300 Virginia Avenue, Fort Pierce FL j4982 COt7llllOrCla� �esidentia€
'Phone: (772) 462-1553 Fax: (772 462-1578
F'ERMIT TYPE:
Andress: 7419�
Property Tax ID #: z
S'e Plan Name:
Fro}ect Name:
j
/ ^ 2b
Lot No. —
Block No.
'.dditional work to be performed under this permit �- check all that apply: Windows/Doors
—Mechanical
Gas ank J Gas Piping � Shutters
Sprinklers Generator
Roof Pitch
Electric — Plu Bing p
Sq. Ft, of First Floor: _ k
oral Sq. Ft of Construction:
ost of Construction $
� . � Utilities: _ Sewer ,Septic Building Heigi~rt: �— -
Name: r
�c 4 1 Company:
Address: d ��
j State: Address:
City: State: f"
Fa c City:
Zip Code: jj Fax:
Phone No. �7�� Zf
Zip Code:
Phone Na
E-Mail: �
Fill. in fee simple Title Holder n next page { if different I StatL-Me ,
I State o Counry License �
from the owner listed above
If value of construction is $2500 oi 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: W _ Not Applicable
Name: Name: _
Address: Address:
City: State: City: State- I
Zip: Phone Zip: Pho e:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
JNot Applicable
Name:
Name:
_
Address:
Address:
City:
_
I
City:
Zip. Phone:
e:
Zip: Pho.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do
the work and installation as i ndica d.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countmakes no representation that is granting a permit will authorize the permit
rIXict with any applicable Home Owners Association rules, bylaws or and coven
which is in co
older to build the subject structure
nts that may restrict or prohibit suci,
structure. Please consult with your Home Owners Association and review your deed for any
estrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all r�spects,
perform the work
in accordance witin 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,
accessary structures, swimming pools, fences, walls, signs, screen roams and accessory uses
to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT
MAY RESULT IN YOUR PAS .NC
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORIDiED AND
POSTER ON TIME JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND
TO OUTAW FINANCING, CONS HILT
WIT OUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
I
I.
Signa re of Owner/ Lessee/ ontractor as Agent far Owner
Sign' of Contractor/
icense `older
STATE OF FLORIDA
ST E OF FLORIIDA�
COUNTY OF
COUNTY OF
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I
The forgoing instrument was acknowledged before me
The forgoing instrument
as acknowledged before me
this day of f _ J 20.4_�by
this day of
2U�A by
Name of person making st ement.
Name of person making
tote
Personally Known OR Produced Identification
Personalty Known
OR Produced identification _.
Type of Identificatio
Type of Identificatio
Produced L Q�-
Produced
1)
(Signature of Notary Public- e of Florida)
(Signature of Notary Pu
k - to of Porida )
Ca " jpr;Nc. Fi " 1rn3'GNiV )
SrG e of Florida Notary Public
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==State of
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SUPERVISOR
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COUNTER
REVIEW
REVIEW
REVIEW
HATE
RECEIVED
DATE
1 COMPLFTED
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Rev.2/7/19