HomeMy WebLinkAboutBuilding Permit Application t
f
All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I I Permit Number:
i
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 _
PERMITTYPE:
I
PRO POSED,INPROVE MtNT LOCATION:
Address: fi)rXeI6Q
Property Tax ID#: Lot No.
Site Plan Name: DG tot Block No.
Project Name:
DETAILEDVESCRIPT10W0F WORK o
k&in Pc•� k !ZDIP pei-he
CQNSTRUCTIO14�INFO,`RMATION:.
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
I '
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: of Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/.LESSEE: CONTRACTOR '"
a- �
Name 611^ dt_k4/t� Name: c) e'. dZ[�K¢_ /bV-rn q
`
Address: (0 ql �o�Gen,S-el Company: N�✓C� (��4s, c
City: 9l+ �'i Zr'64-- State. dl�-L Address: 7-10 SL G a ids l A.a4-,e-
Zip 1"
Zip Code: 3y 111 Fax: City: y '/4_ State:
PhoneNo. y�-7 �y I "?0 y Zip Code: Fax:
E-Mail: �o(�nny' �.,1 .r� Phone No2-
Fill in fee simple Title Holder on next page(if different E-Mail -L-2V4_'L $a 3rd,=1 af--Vy. e ar-�
from the Owner listed above) State or County License
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.
L 1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIONe:
� W �
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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 lender or an attorney before
commencing work or recording our Notice of Commencement.
i
c �
h
Sig ure o 0 r ractor as Agent for Owner Sign e oCo t i rise Holder
STATE OF FLORIDA ll STATE OF FLORIDA
COUNTY OF Fy,irtSL COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by this day of 20_ by
Name of fson king statement. Name of pers n mak g statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( ' ature of Notary Public-State of Florida) (Signature of Notary Public-Statb of Florida)
RpHN11NG
Commission No. S GR #GG275050 ommission No. �.�*�"",. H�9t�@ GRA ',275060
_ p 20le ? +...,;.:#`_ NjYCO�S� gr20. ets
REVIEWS FRONT .. SUPERVISOR PLANS VEGETATION ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW EVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.9/26/18