HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ®(y
SC ANIlit Number:
St. LudeCounty RECEIVE
Building Permit App
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Property Tax ID #: 1 ') V I — LOP - CCRQ — do —H Lot No.
Site Plan Name: �7 Block No.
Project Name: I(�U
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Building Height:
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�9'
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Name 1 F
Name:
n
Address: C
Company: 1 L'i
City: =VleStatea
Zip Cnde-2ws I Fax:
Phone No.
Address:
City:
Zip Code:
Phone No
State:
Fax:
-
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ie-hlE2 i
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.
T 'rI-
Address:
City' State:
ZIP: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
ZIP: Phone:
MORTGAGE COMPANY; Not Applicable
—
Address:
City: State:
ZIP: Phone:
BONDING COMPANY. -
Address:
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.
which isinoconflicawithanyapplicableiHomeOwnerstAssoclatlonirulies,bylaw oriinscovenantsthatmayrestrictborprohibiittsuch
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 concurrenly 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. vour If you intend to obtain financing, consult with lender or an attorney before
�Pm RC R work or recordlrr¢ Notice of Commpn,o.,,o.,,_
—Not Applicable
as Agent for Owner
STATE OF FLz� y' --
COUNTY OF STATE OF FLO�6�A'
COUNTY OF - J� u (1 � e
T6.. i..A_
Ing In m nt was acknowledge me The
day of 2o.L1 oy
Name of person ma i g tement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary
Flod fa
was
day of
by
me
Personally Known Produced Identification
Type of Identification
Produced
Qignat4ure
�Nntmy
tate of Florida)
Commission No. ��gqppubllc Slate of Florid
AmanGa P Sanderson
+,� N g My Commission GG 211256
9i ..d° Expires 0412512022
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