HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONfalI APPLICA4L INFO' MUST oa COMPLETED FOR APPLICATION TO BE ACCEr,tJ * 1
;eate:,� �[ (5—) Permit`Number: c�[T�'
Planning and Development Services
Building and Code Regulation Division
2200 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
SCANNED
BY
St Lucie CounV
Building Permit Application
Commercial Residential V _
W
Address: a - a Y v✓
Property Tax ID #:y 3(-� —y' `� 0 6 G O O / Lot No._
Site Plan Name: Block No.
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank — Gas Piping _ Shutters —Windows/Doors
X Electric _ Plumb
Total Sq. Ft of Construction:
Cost of Construction: $
Sprinklers _ Generator —Roof Pitch
Sq. Ft. of First Floor: C/9 C9
Utilities: _Sewer _ Septic Building Height:
Name uu
c Ll
Address: CVI:C V
City:` � State.
Zip Code: Z `LCW/1 Faxl: l
Phone No. — OFaL
E-Mail:
Fill/n fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
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.
W
DESIGNE
Name:_
Address:
City:
Zip:
NGINEER: _ Not Applica
Phone
State
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
Citv-
Zip: Phone:_
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
structure. Pleasecconsult with yoiOrHlome Owners Association and review your deed or any rest nts that
o s whichrestrict
may ap. prohibit such
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, thelFlorida 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, fend es, walls, signs, screen rooms and accessory uses to another non-residential use
"WARMING 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."
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Sig a ur O ner/ Le e/C � ntractor as Agent for Owner Signature of Contractor/License Holder
I STATE OF FLORIDA S r STATE OF FLORIDA
COUNTY OF l/L COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowled0ged before me
this _day of , 20_ by this _ day of
CW
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification / Type of Identification
Produced \— ` ,M ✓ Produced
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Commission # 2(S&I3
of Notary Public- State of Florida
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REVIEWS FRONT
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SUPERVISOR PLANS
VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
DATE
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COMPLETED
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