HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TOBE ACCEPTED
Date: b(ANNED Permit Number:
REICH" Ora,
Planning and Development Services
Building and Code Regulation Division Permitting D
2300 Virginia Avenue, Fort Pierce FL 34982 L)
partment
Site Plan Name: Block No.
Additional work tobeperformed under this permit —check all that apply:
—Mechanical __ Gas Tank —Gas Piping Shutters Windows/Doors
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Total Sq. FtnJConstruction: * ~~ Sq. Ft. ufFirst Floor:
Cost nfConstruction: $ on 5k Utilities: __Sevver__Sepdc Dui|dingHcight:_______�___
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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 ofconstruction is $I5UOo,more, aRECORDED Notice ofCommencement isrequired.
St1PPLEN�ENTAt CONSfRIJCTEOhI,L1ENGAW;INF,O,E�NkATION
DESIGNER/ENGINEER:
—Not Applicable:.;
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address: = i
Address:
Gity: -'
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
— Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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."
SignaTi3YY'F�° / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA A
STATE OF FLORIDA
COUNTY OF C
COUNTY OF
The forgoing instr was acknowledged efore me
The forgoing instrument was acknowledged before me
thi day of 20 4 by
this _day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Know OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
_
Produced
Produced
(Signature of
ry Public -State of Florida
(Signature of Notary Public- State ofFlorida)
Commission.N
.='•"wt••."•: AUDREYB.(T4, Y
Commission No. (Seal)
'a? - MK 5 300817
EXPIRES: March 6, 2023
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I Thru Notary Public U
Idembm III
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Rev. Z///19