HomeMy WebLinkAboutBuilding PermitAfl AhICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j 'Q
Date: Permit Number: 1 �U
Building Permit Application
ing and Development Services
ng and Code Regulation Division Commercial
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578
RMIT APPLICATION FOR:
Residential �'/
ress: ®� �, ,� C>4 e C)A0%04z G �
)erty Tax ID #:AN11% D. �.LJ�/'{•`/w 1 Lot No.
Plan Name: Block No.
ject Name:
Electrical Meter Second Electrical Meter I
ional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator
I Sq. Ft of Construction: j5 r{ j 15 AQA. Sq. Ft. of First Floor:
Roof Pitch
of Construction: $ 300 Utilities: —Sewer —Septic Building Height:
tJWNEft/LE-�S�S
CONTR�ACTiQR:
Name
Name:
Address: Z
City: a. State: F—:,L
Zip Code: Fax:
Phone No(r�Ma>'3
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Tilde Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
1-t
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
city -
Zip:
Phone
State
EE SIMPLE TITLE HOLDER: Not Applicable
lame:.
,ddress:
IN
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:,
BONDING COMPANY:
Narne:_
Address:
City:_
Zip:
Phone:
Not Applicable
ate:
Not Applicable
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.
Stl 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.
Tiie 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
Signature of Own er)Kessee/Co ntra ctor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE. OF FLORIDA
COUNTY OF COUNTY OF
rn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Preser1ce or Online No
�arization Physical Presence or Online Notarization
day of 21-L0 by this day of . 21_ by
ame of persordmaking statement.
2rsonally Known OR Produced Identification
Lpe of Identification
�(SIgnature of Notary
(Commission No.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
IDATE
'RECEIVED
;DATE
COMPLETED
Rev. 5/b/ZU