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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONNil APPLICABLE INFO MUST BE COMPLETED'FOR A0P1.ICATION TO BE ACCEr��t;:J I' Permit Number: Date: Application SCANNED Building Permit App i Planning and Development Services St Lucie Coun"f. Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Commercial Residential Phone: (772) 462-1553 Fax: (772) 462-1578 CY\ PERMIT TYPE: Address: N ^ � i ©��� � 00 D / a Lot No.__ Property Tax ID #: <3 V o[ Block No. Site Plan Name: Additional work to be performed under this permit— check all that apply: Windows/Doors Gas Piping _Shutters _Mechanical —Gas Tank _ S Roof � Pitch Sprinklers Generator _Electric _Plumbing — P — Sq. Ft. of First Floor: 1 Total Sq. Ft of Construction: ` O '' n Building Height: Utilities: Cost of Construction: $ �J�—� —Sewer _Septic C Name: Name company: Address: Stater Address: City: Fax: Zip Code: �� � � City: Zip Code: �-- Phone No. � �COVY� Phone No _ E-Mail: Fill in fee simple Title Holder on next page ( if different E-MaorCounty StateLicense I 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. Fax: State: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: _ Address: City: Statel: City: State: Zip: Phone I Zip: Phone: FEE SIMPLE -TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: I 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 Buillding 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, sins, 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 PROIRERTY. 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 BEFOG E RECORDING YOUR NOTICE OF COMMENCEMENT." Si a ur 0 ner/ LAe/Cdlntractor as Agent for 0 ner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 1S±LA `A P COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me 20_ by this _ day off/ this _ day of 20_ by �y �• �y�e,, r v Name of person making statement. I Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification` Produced Type of Identification Produced IP"B! _ - - - to ELLEN VA GHN (Sig u Z sa�ldx3 uolsslwwoo AW a ? COmmission ° My Cord # a(giocat, of Notary Public- State of Florida ) 270079 Com �� # uolsslwwo = jd�9 of O°tobm'ssion -- _ er 22, E ire 0 mr W. n No. (Seal) oc 19 d , s d, , NHE)nVA N3113 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.2/7/19