HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO " 4ETED FOR APPLICATION TO BE ACCEPT,-
Date: c yA� _ Permit Number:
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- Building Permit Applicati2019Planning and Development Services Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V_
PERMITTYPE: -10 SCANNED
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Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
_Mechanical
Electric
_ Gas Tank
Plumbing
_ Gas Piping
_ Sprinklers
cation: (Doc)
)
$ 1 22 410(a - — —
Shutters
Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Windows/Doors
Roof _ Pitch
Building Height:
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Name:
Address: I LM ta}
Company:,
City: n— c Oeor, State: LL
Code: Fax:
No. I' %' R?.8' /e y
ZiLE-Mail:
Address:
city: State:_
Zip Code: Fax:
Phone No
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: I Name:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
AAA —-
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
City: City:,
Zip: Phone: Zip: -
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 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
improvements to your property. A Notice of Commencement"must be recorded 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 recordine your Notice of Commencement.
i ,,_Lure of wrnerY Lessee 'ntractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA q I 11.
STATE OF FLORIDA
COUNTY OF �• l j il� ��,
COUNTY OF
The f oing instru s acknowledge efore me
The forgoing instrument was acknowledged before me
this day of 20Jby
I
r
this _ day of 20_ by
Name of persoi making statement. /
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identificat'
Type of Identification
Produced
Produced
(Sig ature of Notary Public- S nature of Notary S
AREN S. NIELSE ( Public -State of Florida )
at of Florda-Notary P 0c
Commission No. mission a GG 207 To mission No. (Seal)
EXPir
ish o o My commissio2n
�;,«.�•" June 12.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/26/ Ifs