HomeMy WebLinkAboutbuilding Permit ApplicationAll APPLICABLEINFFgMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a //( 1 19 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
I PERMIT TYPE: :�&" PDDF
Address: '61,0 7-a—b G
Property Tax ID #: l -3 o l— Lpo q _-
Site Plan Name:
Project Name:
Building Permit Application
Commercial Residential X
p,r c -p F L-
340 s
Lot No. a
Block No. 3
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: [ IFJ�^ Sq. Ft. of First Floor: /QZoz')
Cost of Construction: $ a J Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: L)) A) 0 s
r G
Companwi,
Address:
City: _ 1 i eY CQ-'--- State:
Address: �ff
Zip Code: 1:P111 �1 Fax:
City: State:
Phone No.
Zip Code: q `—_„L Fax:
Phone No
E-Mail.c
Fill in fee simp Title Holder on next page (if different
E -Mail I NAR;'A 0• e2dvYl
from the Owner listed above)
State or County License –
if value of construction is 52500 or more, a KELUKUW Nonce or Lommencemeni is requireu.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
IC
Name:
Address:
city.
Zip: Phone
Not
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip; Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:.
—
Phon
y made to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereb
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 recordin our Notice of Commencement.
;Signature of Owner/ Lesse �nor wner Signature of Contractor/License Holder
STATE OF FLORIDA/ --STATE OF FLORIDA :L Luc-6
OF -r LL) C_(E COUNTY OF <5 t
The forgoing instrument was acknowledge before me The forgoing instrume t was acknowledg d before me
this day of 20 by thisday of __� 20 by
4 � a
tS Ur� U)Oe s %t s u A)
Name of person making statement. Name of person making s atement.
Personally Known >r—, OR Produced Identification Personally Known �OR Produced Identification
Type of Identification Type of Identification
�� Produced
Produced
n �4
utl— V - tpubliC State of Flor{da
{Sign of Notary P Iic�+B ofrbis+tiRljcStateotflaida (Signature of Notary Publ' `1'' FI}jfe6 Flaxen
Desiree Flexen g My C mi ion GG 240688
My Co GG 240688 Commission No. d� Expir 1e?F%2022
Commission
/ No. Expir8 0,22 ' 3NO� �r
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED