HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��
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Date: l$ �"� Permit Number: VI
Building Permit Applica ® ;
Planning and Development Services
Building and Code Regulation Division 1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: v VfY-
Property Tax ID #: ®. Lot No.
Site Plan Name: Block No.
Project Name:
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Additionaf 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: Sq. Ft. of First Floor: �Zq 77
Cost of Construction: $ 2300.C>Z) Utiliti}es: —Sewer _Septic Building Height:
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Name � �i �� Name: YLe2on Ci r,� e
Address: g yfar�j Rq f`, I Company: . COf Joe K dwl& se1NIGe5 UG
City: Lae wot 4-1n State: FL, � Address: 7SUP Uy) 6i OL 5b
Zip Code: 33 Fax: City: WC-A 64 VUGi'r. State: IFL-
Phone No. 5(e 7V5 —j `[ ( Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail Jeof-baw home Ovw
from the Owner listed above) State or County License Sot(o(p
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 Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone :a. 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 IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
i POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH XJUR LENDER OR AVATTORNEY BEFORE RECO DING,YOUR 5111FICE.OF COMMEN ENT."
Signa r of Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STAT OF FLORIDA (" STATE F FLORIDA
COU TY OF J �,{`(A COUNTY OF l �
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this C¢ay of — 20-14 by this_C of_ CNA �, 20 aAby
Name of person making statement. Name of person making statement.
Personally Known OR'Produced Identification Personally Known OR Produced Identification
Type of Identifi ation Type of Identification h
Produced �, Produced
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(Signature of N e. Florida), (Signatu of otary lic State of Florida)
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COUNTER REVIEW REVIEW REV `actobe 22R9QAEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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