HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED jG ++ 1
Date: I Permit Number: 1 11 1 - 001 ` I
o
� f 9•eY �O� 1�1�
Agriculture Exempt Building Permit Application
Planning and Development Services SCANNED
Building and Code Regulation Division BY
4t I_UC e COUrIt
2300 Virginia Avenue, Fort Pierce FL 34982 y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: n.
Property Tax ID #: _ o Lot No. /
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION -
Utilities: _Sewer Septic Sq. Ft. of First Floor: cd.0
2
Cost of Construction: $ 22 5-0 ® Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
floodplain:
Nonresidential Farm Building: J' Temp. Bldg./Shed used exclusively for construction
Mobile/Modular for temp. construction office:. Bldg. involved in distrib. of electricity:_
Other: Flood Zone:_ BFE:_ Floodway? Y/N IfY,
No Rise Certificate with supporting data attached? Y/N
All other applicable state and federal permits shall be obtained prior to commencement: of
construction. -
OW NER/LESSEE:
CONTRACTOR:
Name r
Name:
Address:
Company:
City: li�(,� L State: 811
Address:
Zip Code: Fax:
�_4
City: State:_
Phone No. 567 1 7
Zip Code: Fax:
E-Mail: VJ
14 Ili
&014
Phone No
Fill in fee simple itle Holder o 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.
& I -ALA
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE` COMPANY: Not Applicable
Name:
Addre : ,
City: State:
Zip: Phone 7 "
Address:
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 clothe 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."
Signature of Owner/ ontralffior as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Ll �/
1 M ii �I�
COUNTY OF
The fo tying instr nt was cknowledged before me
The forgoing instrument was acknowledged before me
thisj=dayoft Zile by
this _ day of .20_ by
W; l Iiianal L P'V)ng"
Name of person making statement.
Name of person making statement.
Personally Known NL OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Si
(Signature of Notary Public- State of Florida
R%"'tU11!e;Pfta"n
tsCommissio
Myc1GG
p„,A� YnL_ 0za dal)
Commission No. (Seal)
e
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev.2/ij2019