HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO{{ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Bate:_ "l Permit Number:
- Building Permit Application
Planning and Development 5etvices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)452-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE-
PROPOSED 1NPROVEMENT LOCATION:
Address: `� ,
Property Tax ID :_ 3 1— 00a(.7 `[ Lot No. . }
Site Plan Dame: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTiOtti INFORMATION:
Additional work to be performed under this permit—check all that apply:
Mechanical —Gas Tank —Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 96 C�•00 _ Utilities: —Sewer _Septic Building Height:
OWNER;LESSEE: CONTRACTOR:
Name Gi44'l ^++nA-o� !Name:
Address: 0 Company: AW,Atg z.nc_.
City: - state:, Address: I�
Zip Cade: "1RS1C) _ Fax:_IV City: State: ►�C
Phone No. — q0 — Zip Cade:_ _2(45't-;L Fax: AA+�-
E-Mail: /o (-.p �JTJrt �t�• C /Y/ Phone No
Fill in fee simple Title Holder on next page( if different E-Mail w:' e C¢ ".�
from the[honer listed above) State or County License_ , �
If Value of construction is$2500 or more,a RECORDED Notice of Commencement is reequired.
If value of HVAC is STS00 or more,a RECORDED Notice of Commencement is rewired,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Nacre: Nate:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Add ress: 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 Assoc€ation rules,bylaws or and covenants that may restrict or proh€bit 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 accessary 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 trust 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
SEgnat,lre dyedariner/Lessee one actor as Agent far Ouvne€� VATE
tr ' Cantrecar License Helder
' TMTE OF FLORIDA OF:FLORIDA
COUNTY COUNTY CIF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of -G`` G 20-ft by this day of���-t. rL&44' 20 by
Name of person making statement, dame pf person making statement_
Personally Known OR Produced Ident cat Personally Known 1, OR Produced lden#ifi at'
Type of Identification 'p:. TjOe of Identification
Pr ced Produced
faAj��^P..
l 1
i
� 1
ti
(Si flatdre 'Notary Public-Stag of Florida) M,w (5 ina ure of Notary Public-5tate of Florida c �3 � fi
, , ^3
o ^ �� c
Commission No. `�q (Seal) ro y Commission No.
C (S �
m o�
REVIEWS FRONT ZONING t I R1 5C1 PLANS VEGETATION SEA TURTLE ph4g; E
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.W261 1