HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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 Number:
%4.05aa
SCANNED
BY
Building Permit Applicafiocriunty
Commercial
Residential
Property Tax ID ��1-�t�1-t?l15-ODD-5 Lot No.
Site Plan Name:
Project Name:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of ConstructionCBOY
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Block No.
_ Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: z
Nam e YArl-
Name:
Address• r
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Company:
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City: "rT V1
Zip Code: Fax:
StateErL
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Address:
RGity y . 4 State:_
'Zip Code ` "" i+=i Fax:
Phone NO2�2 � —�o� �.3
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E-Mail:_{
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Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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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
Name:
Address:
City:
State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
Name:
City:
Zip:.
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
BONDING COMPANY: _Not Applicable
Address:
WE
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 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."
U``..<af=`,U_r/ Lessee/Contrac r as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY
COUNTY OF
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OF /�. et.e ,
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this _ day of 20_ by
this day of 204 by
/�
a
y 60 In A, z
Name of person making statement.
Name of person making staternefit.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced
n
A[ 21 Dll'
��Y'uty C� n�
(Signature of Notary Public- State of Florida) ..
Commission No. (Seal) '
.A
(SWatuire of Notary Public- State of Florida)
Commission No.
l;a� 11 AH IASHNAINGRAM•RAH
ING
PIRE . December 20,JW
Y
REVIEWS
FRONT
iIWd 66pS
VEGETATION
SEATURTLE
MANPROVE
COUNTER
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19