HomeMy WebLinkAboutBUilding permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
PROPOSED IMPROVEMENT LOCATION:
Address: aq0 LJ L-Ao, If,s 0 E'ST W Avl
Property Tax ID#: 4p�k4 _ �1oc?• . `�� •O00-C1 Lot No.S o
Site Plan Name: Block No. (CA
Project Name:
DETAILED DESCRIPTION OF WORK:
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FCONSTRUCTION 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: $ 900 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ¢Rrcy-}AR 4 V-gey Name: c Al_mti dA
Address: Rgoy E M le a We s'r w" Company: CLOg.v A l'm T Et N udL09/,r--<
City: FP6e S-�- t.-ucNtr State: !Fi- Address: / 5'77 /vILfi E E. eiz ,
Zip Code: 3 LIe!SL Fax: City: fLT $t c l e_ Stater
Phone No. Zip Code: 39 g6Z Fax:` ?Z- 33� !90Z
E-Mail: Phone No 772- '3 3 S F- v 6 i
Fill in fee simple Title Holder on next page( if different E-Mail C: 9A v a 57 a
from the Owner listed above) State or County License Ae0 5-$ 660
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 LAIN 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Sig, Owner/Lessee/Contractor as Agent for Owner Sign of Contractor/License Holder
A E OF FLORIDA STATE OF FLORIDA
COUNTY OF L„n't coves✓ f COUNTY OF ;S7 Lvc)z cvdA/
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of IMft-L14 20 ZO by this 4Y day of m/yIRC 9 2019 by
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Name of person making statement. Name of person making st tement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
— ),C/VW(, �Ua_ . 'L.J_
(Signature of Notary Public-State of Florida) (Signate of Not -
SANDRA W LSH
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Commission SANDRA W ilfl Commission No. - State of Flori r Public
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Commission c1�o�� �8,;
;_ _ Florida-No ar, ubiic =* *= commission#GG 197964
=* Commission # GG 197984 c
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