HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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tom- u : �•' i i. r k
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
I PROPOSED INPROVEMENT LOCA`1GbN:
Address:
Property Tax ID
Site Plan Name:
Project Name: _
Permit Number:
Building Permit Application
Commercial Residential V
DETAILED DESCRIPTION OF WORK:
9�fb rt _
1 \ vo 0
Lot No._ r%
Block No.
I CONSTRUCTION INFORMATION: {
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:
Cost of Construction: $ ULM
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name q -1A -T�
Addres 4S QShi 1 � W(0LCl✓
City: State:
Zip Code:
Name:
Company: t
Add r ss: S 1\%
City: R,, Q�f 1�[1 St`a�t�e:�C'i'..Ir
tFax:
Phone No. �'~ � �
Zip Code: 31I. ':A�- Fax: qS, t 'LtW_ � Irv,
E -Mail:
Phone No `-'l-p q. I D-,2;15
Fill in fee simple Title Holder on next page ( if different
E-Mail-1;(xIP-5 & san5m-e_ - Ae-- c.m
from the Owner listed above)
State or County License Q._PrC_- US tk1r?3
u value or eonstruujion Is ;i[7uu or more, a Kr6UKUM Notice or Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESiGNER/ENGiNEER: _ Not ApplicableTAdd
ORTGAGE COMPANY: Not Applicable
Name:
ame:
Address:
ress:City:
State:
ity: state•
Zip: Phone
p: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City,
Zip: Phone:
Zip: Phone:
*.. -umy wl■ i r%ns..rain ^rrllJYl1 : Hppiicarion is nereoy 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
hich
wis 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-residentlal 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 your Notice of Commencement. A
Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of
STATE OFF rlDiSTATE OF FL IDA
COUNTY 01 COUNTY OF , L,L)Ct
The f rgoing Instrument was acknowledged before me The fo aing instrument was acknowledged before me
this day of (1 LY 20J3 by this day of ?.-{� 0&t4__,20 by
( NAA Y2Z:
Narne of person making statement Name of perso aking statement
Personally Known OR Produced Identification Personally Known OR d Identiflcation
Type of Iden Tflcation Type of Identification Awwz �
—��"Y DZIEWIT
E POM�SS'on # FF944638
kP1RES; Feb'UWY07 2020
Mss.. _ _
(Slghdture of Notary Public- State of Florida )
Commission No. _ (Seal)
REVIEWS
TI_
Rev. $/2/17
EY (4 4ss DZIEWI ..
YP/RFS: Fe ON # F� T
4�
8
-3 07, X720
(Signatures Notary Public- State of Florida )
Commission No. (Seal)
COUNTER REVIEW SUPERVISOR
I RE EW I PLANS VEGETATION
I S REVIEW I MANGROVE REVIEW