HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPI ICARI F INFn MINT RF rnMPI FTFn MR 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 TYPE:
Address:
Permit Number: — 00 b
SCANNED RECE7ul D
BY
St. Lucie County J U N 0 3 2019
Building Permit Application r
sT. Lucie County, Permitting
Commercial Residential
Property Tax ID#:_n ?z-�o7_ -'no 2 � - wo/d Lot No.
Additional work to be performed under this permit — check all that apply:
_Mechanical .� �' _ Gas Tank' " _ Gas Piping —Shutters —ndows/Doors
_ Electric _ Plumbing,, n_ Sprinklers _ Generator _ oof Pitch
Total Sq. Ft of Construction: - LI (WO Sq. Ft. of First Floor: ? j
Cost of Construction: $ S 1 00C) Utilities: _ Sewer , Septic Building Height:
•cos°•1IL'j'�:.
PRO NER/LE5 EE:
GONTRACTOR:
..'Name._ _Tle_resn'o_.'.Aync8q
Name: i
Company:'- -
'City...,-.. A_0r�r:F,%qrr:= _ Stater
Address;
Zip Code." Fax:
Cityr,'!o,: """' State:_
Phone'No: Z d
Zipodenin•«41' Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
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.
SUPPLEMENTALGONSTRUCTION LIEN LAW INFORMATION:
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 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."
i
Signature of Owner/ Lessee Contractor as Agent for Owner
Sign ure ontractor/L' e
e Holde
STATE OF FLO A I
STAT F F I
COUNTY OF LUU 2.
CO U TY OF
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Rev. Z///19