HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
s.
RECENED
Building Permit Application
Planning and Development Services JUG! 01 loll
Building and Code Regulation Division De rtment
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting
gt. ucle Co
Phone:(772) 462-1553 Fax: (772)462-1578 Commercial Residentia`f
PERMIT TYPE:
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PropertyTax fD #: 'a.'� �� �5-bc'� dd-� Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit—check all that apply:
—Mechanical `Gas Tank `Gas Piping _Shutters Window /Doors
_Electric —Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (p,�(�� ` Utilities: —Sewer —Septic Building Height:
Name Name:
Address: 'Z. 3 fl C _ Company:
State:
City: DLt �i ��C � � . , I _ ,
L :I Address:
Zip Code: '349 b 2 Fax: ;City: State:
Phone No. Zip Code: Fax:
E-Mail: (�)QYI�/(�Of(Jtdyran0&ho al corn PhoneN'o
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of FIVAC is$7,500 or more, a RECORDED Notice of Commencement is required.
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 non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT. IN YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
I.
ignature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOP A STATE OF FLORIDA
COUNTY OF , COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of "3 20a•% by this_day of 20^ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific tion Type of Identification
Produced' ��— Produced
(Signature of Notary lic-State of Florida) ig ture of Notary Public-State of Florida )
��yy DE,\. 0'0 o ,orida
Commission N A. \A vke":b r v eaI State of
otarypubUc 3�spm fission No. (Seal)
"a3 CommisXPiresHa 8 8.2025
omm• N Assn.
of d throug
REVIEWS FRONT I Z Bond R ISOR PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER I R.VIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.