HomeMy WebLinkAboutBuilding Permit Application.z
All APPI irAw F INrn MI IST RF CC'innP� FTFn FnR APPI ICATION TCl RF ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Property Tax ID #:
Site Plan Name:
Project Name:
Permit Number& l��'��3
Building Permit Application
Commercial Residential >—
Lot No.
Block No.
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Additional work to be performed under this permit — check all that apply:
_Mechanical _ GGas Tank• _ Gas Piping /CShutters •�/�Windoowss/�DDoors
I/ Electric (/Plumbing Sprinklers _ Generator . L Roof J� Pitch
Total, Sq. Ft of Construction: Sq. Ft. of First Floor: IS
Cost of Construction: $ /01 Utilities: _ Sewer _ Septic Building Height: 2-0 1--
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Zip Code: Fax:
Phone No. (�
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Fill in fee simp a Title Holder on next page ( if different
E-Mail
e
State or County Litense
from the Owner listed above)
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.
DESIGNS E NEER•
NamAgE
AddCity:
Zip:
Not Applicable MORTGAGE COMPANY: _ Not Applicable
%.� —FiName:
Address:
City: State:
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
structure. Pleafsle consult w with your Hle Home Owners ome Owners Association and review your deed or any ws or and restrictions nts that wh chrestrict
may apply. obit 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 IMPROYEMENfS 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 YOMR NOTICE OF COMMENCEMENT."
for Owner
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STAT/OF FLORID J STA-WOF FLORIDA
�� • ,( )
COUNTY OF U/LCie COUNTY OF &,nle
The f rgoing instrument was acknowledged before me
this of -, 2 by
,L�7-49 m 4 p�P)4!�
Name of person making statement. '
Personally Kno n OR Produced Identification
Type of Identificat
Produced C,
UZip
(Signature of Nota ublic- State of Florida
Commission No.
AUDREYB.HUMPHREY
MY COMMISSION # GG 3qO
EXPIRES: March 6, 2023
REVIEWS ,
DATE
RECEIVED
DATE
COMPLETED
The fgrgping instrument was acknowledged before me
thi day of }7i1QK, 20A) by
J11%9 Z?3T-- 0 ,mLt ae y
Name of person making stat ment.
Personally Known OR Produced Identification
Type of Iden is n
Produced (.^
(Signature of Notar ublic- State of Florida )
MY COMMISSION # GG 3608W
Bonded Thru No ary Public Undemriters
R I REVI W REVIEEW RE I W�
MANGROVE
REVIEW