HomeMy WebLinkAboutBuilding PemitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Application
Punning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address: ti 7 0
Legal Description:
Commercial Residential
Property Tax ID #: C..Oa-7— 000 -- -D.. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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'� i t� � •� C .: 3e Com .e 7'i., _-;r �, 1
CONSTRUCTION INFORMATION:
CONTRACTOR:
Nam
Name:
itiona war to a er orme under this permit— criecK
HVAC 0 Gas Tank E]Gas Piping_
a appy:
Shutters
❑
Address: 2 24
Zip Code: Fax:
City: I-- k Stated
Phone No.
Zip Code: L( C! e�� Fax: Ct & q — l J,) •7
E -Mail:
Phone No. (a �� '! .
Fill in fee simple Title Holder on next page (if different
Windows/Doors
11 Electric El Plumbing
]
Sprinklers
E Generator
Roof u Roof pitch
Total Sq. Ft of Construction:
S�Ft.j of First Floor:
Cost of Construction: $
Utilities: LJ
�lo
Sewer E]
Septic
Building Height:
OWNER%LESSEE:
CONTRACTOR:
Nam
Name:
Address: ✓k c Jrl
Company: cti
City: State:
Address: 2 24
Zip Code: Fax:
City: I-- k Stated
Phone No.
Zip Code: L( C! e�� Fax: Ct & q — l J,) •7
E -Mail:
Phone No. (a �� '! .
Fill in fee simple Title Holder on next page (if different
E -Mail: c
from the Owner listed above)
State or County License: Lr u
rc vaiue or construction is %2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE 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 lender or an attorney before
commencing work or recording our Notice of Commencement.
Sign7ErOF
e of Owner/ Lessee/Contractor as Agent for Owner
STA FLORIDA
COUNTY OF
The f rgoing instrument was acknowledged before me
thi day of w . 201,�: by
Nar6e of person making statement
Personally Known__J4t::.-fOR Produced Identification
Type`of Identification
Produced
Signature of Contractor/License Holder
STATE OF - J
COUNTY OF FLORIDA &"I
The forgoing instrument was acknowledged before me
this ;% day of _ �!r`% 20_L�" by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pubic-,gA#a, Aori
a MIKE MARTIN
i nature of Notary Publ
lorida,p )
Comri�ission No.
.'i°4
.•
N r uhlte -State ofi Florid
Notary Public -State of Flor
w : • # FF 218951
•_
�C'ifl fission # FF 218951
omrnission No. �sslon
r=;.
My Comm, Expires Apr 5, 201
or ° M" om .Expires Apr 5, 2C
"`��
am 0.,
Bonded through National Notary As n.
�+ Bonded through National Notary A
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/'2/17