HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COM�mr-CED FOR APPLICATION TO BE ACCEPTED
—Permit* Number:
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Building Permit Application,,111ng Department
Plan n - g and Development Services St. Lucie County
Buildi g and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
PER
''MIT APPLICATION FOR:
Legal D�scription:
Propefty Tax ID #:
Project Name:
Back: Side: Left Side
Lot No. —
Block No.
-V4
Addpermit— |tnatappiy:
ichanical GasTank Gas Piping __Shutters Windows/Doors
�^ Electi~�`Plumbing Sprinklers __Generator Roof Pitch
Total Sq. Ft of 'Sq. Ft. of First Floor:
1 U . 'Sewer 1'ZSeptic Building Height:
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Zip Code:'
City: ha/-�- State:
Fax:
simple Title Holder on next page (if different
Fill in �f6e
E- M a 11 .e �Iele /Zo
from,thp
Owner,listed above)
State or County License
If valuol'of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not
Applicable
MORTGAGE COMPANY:
Applicable
Name:
Name:
_Not
ill- ,
Address:
Address:
ICI
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
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 onprohlbit 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 your paying twice for,
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before the first in�ion. If you intend to
obtain financing, consult with lender or an attorney before
commen 'n w rk or'recording;,yAA1 otce of Commencement.
SignatuW of Owner/ Lessee/Contractor as Ag t for Owner
Signature of Contractor/License Holder
it
STATE OF FLORIDA
STATE OF FLORIDA
;!
COUNTY OF L
COUNTY OF G i-w .e
The forgoing instrument was acknowledged before me,
The forgoing instrument was acknowledged before
me
this day of ACA, 20by
thisZ,�day of 20L?by
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AN
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(Name of person acknowledging)
(Name of person acknowledging)
( ignature of Notary Pub ' -State of Florida)
(Signature of Notary Public- Wti of Florida )
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ^^�
Type of Identification
Produced �/ \
�
Produced
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Commission No. (Seal)
Commission No. (Seal)
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