HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
Date:
AIPLETED FOR APPLICATION TO BE ACCEPTEu
Permit Number:
- - - Building Permit Application
a
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
Address: �`,!y �y
Property Tax ID #: Jqu:z (900
Site Plan Name:
o�.,iort �I�mo
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters
_ Electric — Plumbing t _ Sprinklers _ Generator
Total Sq. Ft of Construction: d� Sq. Ft. of First Floor:
Cost of Construction: $ .306 Utilities: .—Sewer _Septic
Name 1111CDGOI rN oiG.,gow-n
Address:-3 v '
City: State?
Zip Code:3 c� Fax:
Phone No.720 —J -Y — 8S
E-Mai • �% �Z � �
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height: q
QlJ#�-
C
Name::
ompany:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
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.
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _Not Applicable
Name:
Name:
Address:
Address:
State:
City: State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: — of 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
Owners Associattion rules, bylaws or,,and covenants that may restrict or prohibit such
which is in conflict with any applieable.Home
structure. Please consult with your Home Owners Associa'tioh and review your -deed for any restrnctions:which may apply.
In consideration of the granting of this requested permit, I do hereby;agree. that I will, in,all.respects,,perfgrm 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 IMPROVEMENT YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB: SIT ' BEF RE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER O A `.X EY 13EFORE RECORDING YOUR NOTICE.'0F COMMENCEMENT."
i
i
Signature of Owner/ ee/Contracto as ent for Owner Signature of Contractor/License Holder
STATE OF FLOR STATE OF FLORIDA
COUNTY OF COUNTY OF
The for�gnepin�g instrum tw acknowled eforelme The forgoing instrument was acknowledged before me
by
this j'�day of 024 by i this _ day of 20_
i
Name of person m ing statement. Name of person making statement.
I' Identification
:,',P,ersonally Kno n OR Produ e ific a wn OR Produced
Type of Ident' ication e d tificat` n
C\
Produced Produced
(Si to of N ary Public State of Florida gnature of•Notary Public -.,State of Florida) '
^ Y1SA JANE CA
Commission No. C6-iLI lcg � 2 (Se mission No. (Seal)
�Y COMMISSION # GG94 "6
�
"a,�a, GXPIR6S: December 19, 023
REVIEWS
FRONT
ZONING
SUPERVISOR �
PLANS I
.
VEGETATION
',;
SEATU,RT`C �%
REVIEW,,,
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW"�''°REVIEW
,
DATE
RECEIVED
DATE I
COMPLETED
ev.
i
i
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applica ble
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
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 norr-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 RECOR®ED AND
POSTED ON THE J TE EFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
TH YOl1R LENDS AN TTORNEY BEFORE. RECORDING YOUR NOTICE OF COMMENCEMENT."
kL�e'
of Owner/ Lessee/Contractor as Ag nt for'Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF ---
The forgoing instrument was acknowledged before me
this day of by
The forgoing instrument was acknowledged before me
this _ day of 20_ by
ame of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificati /
Produced '(�
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of „ N H N
SPRY PUB �i
State of Florida -Notary Public
Commission *= om—ission #(601270079
9 e� My Commission Expires
---.-October 22, 2022
(Signature of Notary Public- State of Florida }
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW,
PLANS I
REVIEW
VEGETATION
( REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.