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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: •
Building Permit Application
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:
- 1 31 • ��3'� ' �wJ Lot No.
Property Tax ID #:
Block No.
Site Plan Name:
Prniect Name:
FIR �
5J.L. `rb
4 %4
Additional work to be performed under this permit— check all that apply: .
Mechanical Gas Tank — Gas Piping —Shutters _Windows/Doors .
Electric — Plumbing —Sprinklers —Generator -`'
%oof `R: 'Pitch
Total Sq. Ft of Construction:
Cot-off Constr:,uctior 4 `jg0C)
Sq.,Ft. of First Floor: _
Utilities: —Sewer —Septic
City: I' State:
Zip Code: Fax:
` c
Phone N
F-Mail:
Building Height:
Name:
Company:
):Code.;'
ohe No'- - -
Fill in fee simple Title Holder on next page ( if different E-Mail
from the_O;wner listed above) 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.
State:
46
NMI
DESIGNER/ENGINEER _ Not Applicable MORTGAGE COMPANY: — Not Applicable
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'Gounty 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 ARID
POSTED. ON THE, JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE.REC071viRdC,!r0! 13:NOTICE OF COMMENCEMENT."
:e ,S
Sign e of Owner/ Lessee/Contractor as ger t Owner Signature'of Contractor/License:Holder
STATE OF FLORIDA — STATE OF FLORIDA
COUNTYOF <t o COUNTY OF
The forgoing instr ent was acknowledgecJ�,b�fore me The forgoing instrument was acknowledged before me
this by
_ day of 20_ by this day of
Na of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
T e of Identification Type of Identification
P o uced Produced
( ignat otary Pub i - t of Florida) (Signature of Notary Public- State of Florida )
ommission No: �,� pM.Rq}{M1NG Commission No. (Seal)
si '•' fig? W S81 O GG 275060 I a
REVIEWS FR �''°P PLANS VEGETATION SEA TURTLE MANGROVE
COU ER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED