HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��►►
Date: Permit Number: 1q®l; lJCJ l
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I..Mi
Building Permit Application
Planning and Development Services
Building and Code Regulation Division VV-0&4-
2300
im, -2300 Virginia Avenue,Fort Pierce FL 34952
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: bO A
PROPOSED INPROVEEME/NT LOCATION;
Address:
Property Tax ID#:% �� n r � —� —°`9 Lot No.
Site Plan Name: Block No. 7b
Project Name: <-Pt b�--r tu"o
i
DETAILEDDESCRIPTION OF WORK:
61
CONSTRUCTION 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
I
Total Sq. Ft of Construction: /-700 A` Sq. Ft.of First Floor:
Cost of Construction:$ 6,2`J b e Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name MkS /E Name: CJd(Ccs`�-n�► �� . K
Address:3a(4( Pi�r� Com' Company:W J t Uw-
City: State.& Address: /06AY1'L�rO
Zip Code, 3gjj Z Fax: City: r� 31effz!'�q State:/
Phone No. Zip Code: J���� - Fax: Z-
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-MaiI1-fe(ecc,04-7-;77 er ) A4 CG�x
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 reco1j:ring your Notice of Commencement
Y P
S ature o n Les e/ ontractor as gent for Owner Signature of Contr c . r Lice c der
STATE OF FLORIDA STATE OF FLORIDA1�,
COUNTY- OF 9�. a . COUNTY OF ISA
The for oing instrument was acknowledge before me The for oing instrument was acknowledge before me
this day of 1201-) by this day of 20-D by
Name of person making statemen Name of person making statement.
Personally Known 5 OR Produced IdentificationPersonally Known & OR Produced IdentificationF
Type of clentif carion Type of Identification
Produced � �.�I�n�( Produced
na re of Notary Public- tate of Florida) ignature of Notary Public-'State of Florida)
Commission No. (Seal Commission No. (Seal)
ING A MING
,' COMMISSION#. 275060
REVIEWS '� C M 1A� PLANS VE �,l{ JIG VE
11 11 REVIEW R Ptft
DATE
RECEIVED
DATE
COMPLETED
Rev.9/26/18