HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP FETED FOR APPLICATION TO BE ACCEPTED 'qw- , )
Date: Permit Number: 710 3 — &� -Uv
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Building Permit Application
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Commercial Residential,����'���
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank _ Gas Piping —Shutters
Lot No.
Block No.
ys Windows/Doors
NElectric _ Plumbing _ Sprinklers _ Generator 7e Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ kotmo WIC.
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Name A' 4 , L
Address:��
Cit Y J(: % State: R"
Zip Code: Fax:
Phone No. `L— d
E-Mail: fII24A V/ °
Fill in fee simple Title Holder on next paa ( if different
from the Owner listed above)
-Name:-'
Company:
il
Address:.
City:
Zip -'Code:
Phone Nb
E-Mail
State:gr'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.
Building Height:
Fax:
State: .
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_ Not Applicable
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Name:
Address:
Address:
State:
City:
State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby maoeto ootaln a perin1L uU L11_ N o.,�
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
structure. Please consult w with applicable
lome Owners Asse Owners ociation son and reviewyyour dws eed or any restrictions and covenants that wh chtrict or may apl. prohibit such
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 IMPROVEMENTS 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 BEFOf2E RECORDING
YOUR NOTICE OF COMMENCEMENT.
Signature of Contractor/License Holder ..
Signature of Owner ntractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
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COUNTY OF
The forgoing instru n
w s <nowledged before me
The forgoing instrument was acknowle20ged before me
this day of
20_ by
this _,day of
Name of person making statement.
Name of person making statement.
Personally Known
OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State o rida) '�o90q» 7W
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Commission No.
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Commission No. (Seal)
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DATE
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