HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APJ,(QN 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 TYPE:
Address:
zuz,
�ermltting �
i
Building Permit Application
Commercial Residential
Property Tax ID #: _ 7�W)2 ' (/ �� � �. Lot No.
Site Plan Name: Block No.
Project Name: I ,
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing_ Sprinklers
Total Sq. Ft of Construction:
V
j 4
Cost of Construction: $ !� Utilitie
Nam
r
City: R, �� State:
Zip Code: 4_ Fax:
Phone No. �t�S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_ Shutters _ Windows/Doors
Generator oof %,� ANp 'Pit
Sq. Ft. of First Floor: e GIc'
s: tsewer _,Septic Building Height:_
Company:ANL)KUJ UUN'b I KUV I IUN.LL6
Address:
City: �t�t�:
Zip Code: K:
Phone No
E-Mail ,�11✓` S�/��t/ f�l'i,T./�1�f��/�
State or County !License /GZAZ�,2,�,�
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION �
DESIGNER/ENGINE : Not Applicable MORTGAGE COMPA Not Applicable
Name: %11 Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
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 indicate
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 conflicts with any. applicable Homeowners Association rules, bylaws or and'covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, cons
with Jvnder or an attorney before commencing work or recording your Notice of Commencement.
Z.
i a ure of Contractor - or - O ner Builder as applicable
STATE OF FLORI[�A
COUNTYOF _i" r" t
Sworn to (or affirm d) and subscribed before me of � Physical Presence or Online Notarization
; 1
this day of (� ,�*�� , 20 Eby
Name of person making statement.
Personally Known V. OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida) ,�lSheniqua S. M111nS
E% �AN ISSIi1�i � OGiJ 9
Commission No.�, .> (Seal)
_
EXPIRES: Sept. 9, 2022
Af Bonded ft Aaron Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED