HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLI� INFO I)lIUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U q umber: [90S-C)(DSS—
SCOW
BY
St. Lucie CountV �tecexvev
Planning and Development Services Building Permit Application I'll
Building and Code Regulation Division "'9 0 coJ��
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579 Commercial Residential.
PERMITTYPE:
P RO P 0 5 E D11 K4 P RID9, E KI E NN ffo-c-Nl 0 N
Address: 5 / b q 6 Lffvs 4,i- 6 L VD yl�- ��,z 6 4�- Z?L/ y
Property Tax ID #: Sq 0(a--UC)j- Otqq. Lot No.
Site Plan Name: Block No.
Project Name:
110EITfAl HEWOESGRI U110M =0 R K�
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VIM S Ml R U I -KI I g 1, N� I I N, &@� R M AT I Q N
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank Gas Piping — Shutters —Windows/Doors
— Electric — Plumbing Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: 10 — Sq. Ft. of First Floor:
Cost of Construction:$ Util ities: —Sewer —Septic Building Height:_
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Name—
Name:
Address:
Company:
City: /Z State:
Address:
City: State:—
Zip Code: 3 Y;� k 2� Fax:
PhoneNo.
Tip Code: Fax:
E-Mail:-�hrll hTq,3 � e-6(nAi L-� eg"
Phone'No
Fill in fee simple Title Holder on next page (if different'
E-Mail
State or County License
'Commencement
from the Owner listed above)
;f value of construction is $2500 or more, a RECORDED Notice of is required.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
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 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 IMPROYEMENTS 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
RLILURUIINU YOUR NOTICE OF
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Signature of Owroeessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF �VA
The folgqlng nstr t �as acknowledged before me
this C�A day of by
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 by
Name of persot0makir;i-staternht. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
An ll�z
(SiWatdre of Notary Public- Stble of FlOrida ) (Signature of Notary Public- State of Florida
Commission No. (Seal) _____L&ommission No. (Seal)
REVIEWS FRON�J�""'. INOFIRE :91ADEFAVA41
ILANS � VEGETATION SEATURTLE MANGROVE
COUNI 0-i-111 fiWw ThIWAM�W 18 VIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED