HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — l 7?- ) -/ Permit Num
SCANNED
BY
't Uicie County
Building Permit A
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 V
PERMIT TYPE:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:_
-//I,f J/Jf JI_
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: ,I
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:_
Cost of Construction:$ 111:500-�2 Utilities: _Sewer _Septic
✓ Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR . '.
Name
Name: k
Address: 3 e
Company:
City: State: j�
Zip Code: Fax:
Phone No. - /(0•
Address:
City:. rnt ^ Stater
Zip Code: A 91�o a Fax:
Phone No J %•
E-Mail:/ .
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
/
E-Mail �1�'oyg l
State or County License
It 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.
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SUPPLEMENTAL CONSTRUCTION Ulf" - W INFORM'ATIQ[V:•
_
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DESIGNER/ NGINE R:
Name:
_ of Applicable
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MORTGAGE COMPANY: _ Not Applicable
Name:
Addres,!
Address:
City: V o
Zip: Phone
State: !
a -Co 2(a
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
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 E JO SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
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Signature of Owner essee ontract6r as Agentfor Owner Signature of Contractor/License Holder
STATE OF FLORIDA r/ STATE OF FLORJEIA
COUNTY OF J T LGLil COUNTY OF _ ( I_U__,�k
The forgoing instrument was acknowledged before me The fo oing instru t was knowledge efcre me
this day of f , 20_' by this day of 20by
Derek Foxx
Name of person making statement. Name of rVrson making st ment.
Personally Known OR Produced Identification Personally Known OR Produced Identification _
Type of Identificati n Type of Identification
Florida 5 I (Signature of Notay//aubric-State of Florida)
Commission No. GG242913 V
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C .ar rr,-unenm �F'6fe 5FTe of Florida
REVIEWS FRONT ZNINGI COUNTER I REEVIEW I S REVIEWUPERVISOR� PLAN RE E REVIEW MANGROVE
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