HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C
Date: a-� `-I Permit Number ` I o5O
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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
PERMIT TYPE:
PRO OSED INPROVEMENT LOCATION "
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Address: 60 �2V ` CMO SLA -F r-1- purce -FL �) gJ5
Property Tax ID#: /JD/- LOC -00 V,5 -O00 - O Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OE WORK 1 K k
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CONSTRUCTIO I INFORMATION
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Additional work to-be performed under this permit-check all that apply:
_Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors
_Electric _Plumbingr. 1 I prinl _Generator _Roof Pitch
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Total Sq. Ft of Constructiori at,,,), (pSq. Ft.of First Floor:
Cost of Construction: $ 9_,P0.0° Utilities: _Sewer _Septic Building Height:
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OII .INER/LESSEI *W � ONTr ms`s
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Name Ps ^'1y •Fs 5 1.1-44 Name:
Address:.7.3c93 e Sel cold R c ' Company:
City: rp ik” P1 e t' 4. State: FL Address: • - •
-
Zip Code: 3(4 9 S I I Fax: . City: State:
I Phone No._272,`g 2,2,-5(046, Zip Code: -. . Fax:
E-Mail: A m y y f la@9}mcyiI ,
�11.1 PhoneNo
Fill in fee simple Title Holder on next page( if different E-Mail .
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 CONSTRUCTIQN�LIEN LAW INFpRMATIQN .. .. ... F .,. . EE., #4z... .
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 your Notice of Commencement.
cigniAryr
ature O r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA • STATE OF FLORIDA
COUNTY OF SE L,.0 A C1 COUNTY OF
The for joing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ( day of M-Z7 ,20/7 by this day of ,20_o � rn�
by
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Name of person aking statement. -. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced l,, (,i Produced
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(Signature of Notary Pu A-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. EE EN VAUGHN ommission No. (Seal)
1vf P(i8/�
State of Florida-Notary Public
*_ Commission #G ••
' Ty Commission Expires
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Oct^ e_� _� r.
REVIEWS FRONT _ -a PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW Y REFUT `' EVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.9/26/18