HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
C0UNTY
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:
PROPOSED IMPROVEMENT LOCATION:
Address:��
Property Tax ID #
Site Plan Namc
Project Name:
DETAILED DESCRIPTION OF WORK:
[CONSTRUCTION INFORMATION:
Building Permit Application
Commercial
Residential
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: p� Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic
OWNER LESSEE:
NameI
Address: .) 'd► M"W" Hvti.
City: Pt. ffek-� State: ri.
Zip Code: --� Fax:
Phone No.5�Q I -JW y] —7-3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Windows/Doors
Roof Pitch
Building Height-_
CONTRACTOR:
Name:
Company:
Address.
City: State. F
Zip Code: t
Phone No L
E-Mail
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.
u
$0PPLEMENTAL CONSTRUCT10N LIEN LAVA INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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, 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of , 2020 by
Name of person making statement.
Personally Known _
Type of Identification
Produced
OR Produced Identification
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
4, Im, J�� 4A�ZC--
Signature Cont ear/License Holder
STATE OF FLORIDA COUNTY OF JIK, F
Swof n to (or affirmed) and subscribed before me of
SJ Physical Presen a or Online Notarization
this day of -+? d 202L7-. by
.I --1--)o,pnL
Name of person making statement.
Personally Known VZ OR Produced Identification
Type of Identification
(Signature of Notary Public- State of Florida )
Commission No. G6 g1g7gt0 Se
SUPERVISOR PLANS I VEG
REVIEW REVIEW RE
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