HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
0.
- - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Legal Description: ! �a
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Property Tax ID #: 0 a -0(F6 3 ._d o o — Lot No.
Site Plan Name: %(J_ -cc c� vc C Block No.
Project Name: 5 (3- L-6, C�UV� C Vim`
Setbacks Front Back: Right Side: Left Side:
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c a that apply;
_Mechanical Gas Tank Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer —Septic Building Height:.
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Company:_4c� Cc�vc�`,Iif6t�i lli !';r,
Address: U c.e�
City; State:-
Zip code: l Fax:
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City: �t ; t; _ State:
Phone No. - " 3'
Zip Code: 3 YI — Fax:
E-Mail:
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Fill in fee simple Title Holder on next page (if different
E-Mail Crc�f1 �r
State or Coudy License 13 m _
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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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 County Amendments,
The following building permit applications are exempt from undergoing a full concurrency review_ room additions,
accessory structures, swimming pools, fences, wails, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordingyour Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner I Signature of
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF JALCG �- _ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this !3 of 20�by this _ 1 day of � �a n UI& rL __. 202J Z by '
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(Name of person acknowledging) (fume of person acknowledging)
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(Sign atre of Notary Public -State of Florida } fa ?2 (Signature of Notary public- State of Florida )
Notarization validates
Personally Known iI"- OR Produced Idefi atom ly, Personally Known OR Produced Identification
no documant content Type of Identification
Type of Identification _<<31/Z4
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Commission No. U1 �,'
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