HomeMy WebLinkAboutBuilding Permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L_1 12rU 11 Permit Number:
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 Residential
Haaitipnai worK to DIenlIertormea
HVAC UGas Tank
11Electric F-1PlumbingSprinklers
unaer tnis permit— cnecK an apply:
E]Gas Piping _ Shutters
❑ Generator
Windows/Doors
❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cv
Cost of Construction: $ 15175q C Utilities:
S Ft. of First Floor:
_ Sewer Septic
Building Height:
Name l nius l i a tmcrrd
Address: 11 .1 ccat lel b c'i -
City: c � Irl K n A State:
Zip Code nHgS-1 Fax:
Phone No. i CGt✓) - SC J . 9) -1 !
E -Mail: I 0rl'lUrl{ Q0 1�CG .Ccry 1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: DCt r') I C, I `j )-yXU j
Company: f' 1 r-
Address:COX 1
City: n't >e r�L �(/l Stater
Zip Code:_3__(C S 2 Fax:
Phone No. �; `� ' <J�' �-1S'z�) {
E -Mail: In to aso I icon(J'i tonins
State or County License: C I S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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LEMENTAL CONSTRUCTION LIEN LAW IN ATION
DESIG R/ENGINEER: _ Not Applicable
MOR AGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Ph
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 jobsite
before the first inspection. If you intend to obtain financing— consult with or an attorney before
commencing work or recording our Notice of Commenc e . :_----�
ignature of Owner/ Lessee/Contractor as Agent for Owner
Signature C c or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF f l ( (} t .tel
COUNTY OF M 0 -y}-t rl
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 'Z -a day of ADa r'. f 20 1 '� by
this 2_--3, day of AVT t i 20_L�3 by
01
Name of person making statement
Name of perso making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id -1 ZoI
Type of Identification
Produced 6
Produced
? tf, u is State of Florida
a Michell; Gilmour
MY C , mission GG 19,46r 3
? Ex
ggn
(Signa re of Notary Pu li - tat r
NCO u FAhaUtdidfi�lleifflifei�ur
�.. c Commission GG 194663
?ate Expires 03/11/2022
Commission No. (Seal)
Commission Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17