HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
• MAC'
Building Permit Application
FerrnttPlanning and Development S l rvices s, +t+elr�Cou ty
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: r + S• ��OU�IA� 7I IJ�IZ �i2-• t C � (�Property Tax ID#: �� 003-010-& Lot No.
Site Plan Name- Block No.
Project Name:
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Additional work to be performed ,under this permit—check all that apply:
_Mechanical Gas Tank ^Gas Piping _Shutters `Windows/Doors '
Electric I Plumbing _Spri klers _Generator _Roof Pitch'
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Total Sq. Ft of Construction: ..ZZ �°q Sq. Ft. of First Floor:
Cost of Construction: $ rj�tI'D Utilities: _Sewer _Septic Building Height:
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Name F&6?tz F. eL A) {�' A Name: U l s �l�l�''I /�
Address: 41(0( S• M%1 1 � 2Z(JQ2ITL. Company: 56 l�e�"70 /�
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City: -F- , 17,eWZ State:F Address: 2U ` r �
Zip Code: ,3l 1 Fax: City: v efz lv State:
Phone No. 306',335 `hN� Zip.Code: �2ICP Fax:
E-Mail: Phone No '7r72- 36d V161
Fill in fee simple Title Holder on next page( if different E-Mail ��IS `t > �h�t'�Q ae✓`�s ��' C°Y'!
from the Owner listed above) State or County License (feC t3.325W CC)
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.
4DEStGNER/ENGINEER: —Not Applicable 7Addr
ORTGAGE COMPANY: _Not 7Appricable
Name: me:
Address: ess:
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 ON YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTI E Of CORK! ENCEMENT.-
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF !-=�— L.y jam,^ COUNTY OF ��— LA-t,[I'1-
The forgoing instrument was acknowledged before me The f oing instrument was acknowledged efore me
this�day of 20�by this day of 20�y
Name of person making statement. Name of person making statement.
Personally Known OR Produced IdentificatiA ' Personally Known OR Produced Identification
Type of Identification Type of Identifica n
Produced J� Produced /
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(Signature of Notary Public-Sta f Florida ) n �,( gnature of Notary Public St e of Florida C)
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Commission No. (Seal) �z C mission No. (Seal) ��o
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REVIEWS FRONT ZONING SUPE ANS VEGETATION SEA TURTLE ( '
COUNTER REVIEW RE E `K IEW REVIEW REVIEW
DATE ' ` @ C
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DATE
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