HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA
FOR APPLICATION TO BE ACCEPTEL- -
SCANNED Permit Number
BY
St. Lucie County
i010'001q
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: P ,n M n./ nl , 71 n
Address:
I
Property Tax ID #: y
Site Plan Name:
Project Name:
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!ITION OF ••
RECE[ft
OCT,012019
Pemiltan
St Lu e RD
countye�t
Residential Y
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CONSTRUCTION INFORMATION:
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 Constructi Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: -Sewer _Septic Building Height:
I
OWNE%R/LESSEE:,` ,
CONT CTOR:
Name
Name:
Company:
Address:
city:. l State:
Zip Code: LR Fax:
Phone No.
Addre
City: 11'' State:_
Zip Code: T x:
R"ne No I • '
t$ie�iNntvrticense U\C_
E-Mail:
Fill in fee simple Title Holder on next page (if different
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.
6
SUPPLEMENTAL CONST 6N 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 TITLEHOLDER: _ 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."
W e
i nature of Owner/ ssee/Contractor as Agent for Owner
STATE OF FLOI I ' ` ' n
COUNTY OF OJT. bi � v
Signature of-Contractor/.License Holder
STATE OF FLOq
COUNTY OF (mil
The!,
The r i insj n e rp�n�
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The going in a eclre�r�
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Name of person making stat ment. \-
Personally OR Produced Identification r
Name of person making statement.
Personally Known OR Produced Identification
Type of Id i at
Produced
Type of Identific ion
Produced
(Signature of Notary� Public -State of Florida)
(Signature of Notary Public -State of Florida
CommissionNlt✓�� N.BURNS
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