HomeMy WebLinkAboutBuilding Permit Application IAII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ®� •O
Date: Permit Number: I`I�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (7.72)462-1578 Commercial Residential
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PERMIT TYPE:
"PROPOSED IMP�ROVEMEIVT
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!Address: -11'1 NL� 1So1-
:Property Tax ID#: �1 ! - 515 -C?1 3r?- O o O a' Lot No. :13
Site Plan Name: Block No. a
Project Name:
D:ETAI'LED DES`CRIPT,I'ON
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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 V Roof Pitch
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Total Sq. Ft of Construction: o��SG Sq. Ft.of First Floor:
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Cost of Construction: $ �a lz) Utilities: —Sewer —Septic Building Height:
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OWNER%LESSE `v
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NameA (N A-'I WotnoO anIhlczJJi Q..l1,o��ss,,. Name: olCfQ__W
Address:'?-7c/ Ltgy\r_ "SJ-. Company: S k.6«(���
City: P6C-�-S C� '0- L_'C4 - Stater Address: 1113 SW
Zip Code: d4-- Fax: City:P os k- S c.',11- L'A Lt State:f_t
Phone No. Zip Code:3 y S V1 Fax:
E-Mail: Phone Nol^1 a'--x(00—9.E0
Fill in fee simple Title Holder on next page(if different E-Mail S o . Go
from the Owner listed above) State or County License C C_
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.
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- �I SUPPLEiVIENTA'L��CONSTR„UCTION LIEN LAW INFORMATION � � � �� � f�� {,s3 �,„` ,����`
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DESIGNER/ENGINEER: Not Applicable ~MORTGAGE COMPANY ?,; °:; _Not Applicable
Name: Name: _ -
City: State: City: = State:
Zip: Phone Zip: Phone:'_x
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:..;.,.. Not Ap'plicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 JOB SITE'BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN!ATTORNEY BEFORE RECORDING YOQIR NOTICE OF COMMENCEMENT."
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Signatu a of Owner/Lesse / ntract as Agent for Owner Signature of Contractor/Lice se Hold6r
STATE OF FLORID STATE OF FLORIDA
COUNTY OF .( l j COUNTY OF �T
The tf^or�oing instr nt was cknowledg efore me The fo�gping instrument was a knowledg before me
this�S 1 day of � 20 by this day of 20 by
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
I Produced Produced
dJ_ y wko ,
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(Signature of of ry Public-State of Florida) (Signature ofof ry Public-State of Florida)
�l�t►Y?u BRANDY M00 ` Q' �►nY Pue�/ BRANDY MOOR,
Commission No. y I O {'�� ��al) Commission#GG1 ��mmission No. I��VJ, �ocommission#GG 10 8
Expires May 9,20 1 oY Expires May 9,20 1
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BandedThruBudget Notaryervl000 ��a_ `oP� BondedThruBudgetNotary8 rV e
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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