HomeMy WebLinkAboutHWH PERMIT APPLICATIONAll APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 APPLICATION FOR:
Address:
Legal Qescription: a
•
Commercial Residential
IN
CC NST iJ TfON tt�iF0�11 T#Q�
Additional worK to lae pertormed under this permit - check all that apply:
_Mechanical _ Gas k _ Gas Piping _ Shutters _ Windows/Doors
— Electric P✓ lambing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /02/ . Utilities: —Sewer —Septic Building Height:
-
Nam (1
Name: 6
Compa y:
Address: Q
City:/ lYi e /cA
Zip Coder �� /n��-
Phone No %�� — y(
/'L D
�2
np
Stater
Fax:
%-Ze-
Address: 7w (1 VD51
City: e r _e_ State. _
Zip CodeoS-„� Fax:
Phone No. _"% 7� -- , - S — O ��
E-Ma n �d C 7
Fill in fee simple itle Holder on next page ( if different
from the Owner listed above)
E-Mait'�c p
!O r0 /, v�
State or County Li erise C�'C D
f value of construction is 2500 or More.;; RFrnRnFn luntira of (nmmonrnmcnt i� .a.,,..e.a
SUPPLEMENTAL CONSTRUCt'ION LIEN LAW IN
_l3ESIGNERfENGINEER: Not Applicable
Name:
Address:
City State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not:Applicable.-
Name:
Address:
City:
Zip: _ Phone;
[ON:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ,Not Applicable
Name:
Address:
City:
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 wort:
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 BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as QA -ntfor Owner I Signature of
STATE OF FLORIDA• STATE OF FLORIDA c !
COUNTY OF `_4 11J G{ e COUNTY OF '5 ��t1Li
The forgoing instru ent was acknowledged before me
this ?_ day of i / 20o2- by
Name of person making
�sf4t�_
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- St
/ oyTI^ Notary Public State eFlonai
ld
Commission No. 1r�iJ�r •' ($' hose L sion GGButterfi30
_ d omrrouion GG 302465
EXpres021142Q23 -
REVIEWS I FRONT I ZONING
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
The forgoing instr ent was acknowledged before me
this --dray of_,�l� i34- 120 -:-)1 by
Name of person making st#tement.
Personally Known OR Produced Identification
Type of Identification
of Notary Public- State of
L — !terfv
mission No. ` �eel) °'ei ssa i3utterGG
SUPERVISREVIIEOR I REV EW NS VRE EWON SEA REVIEW RTLE I REVIEW