HomeMy WebLinkAboutPermit App 8421 Belfry Pl All APPLICABLE INFO MUSST�BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit 9 Permit Number:
COUNTY
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginio Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: YY1� C.,11_lC_Ct_`.
PROPOSED IMPROVEMENT LOCATION:
�'
Address: On- ^,
Property Tax ID##: CJ -Q_ (-_,-L Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
tii U
CONS:RUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_VMechanical _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:$_s Lj -!L�. Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1 VA 0 - Name: - V6 a 1 RM
Address: 3
V Company:
P y:
City:. r St Addres a✓L
Zip Code: t+ Fax- City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page if different E-Mail rr CLWN
from the Owner listed above) State or County ticense�,�1��b(P 75
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,5o0 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: �W 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: Narne:
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 YHE JOB SITE BEFORE THE FIRST INSPECTION. IF U INTEND TO OBTAIN FINANCING, CONSULT
WITH'IOUR ENDER OR AN ATTORNEY BEFORE RECORDING YO NOT E OF COMMENCEMENT,"
S gq@ a of Owner/Lessee/Contractor as Agent for Owner Sig ature o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA [ t
COUNTY OF COUNTY OF
The for oing instr nt was cknowledg efore me The f oing instr e t wa acknowledg efore me
this, day of� ,20 by this day of '�I 2fi by
(v-t At 1(i cc Ciro,kri(—V— W,I �1Z V
Name of person making statement. Name of person making statement.
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of identification
Produced Produced
(Signature of Notary Publi MAN (Signature of Notary Public-State of Florida
QANBLI-�M
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Commission nt '' -. tissfoN 1d59 ; +'rr,., CiAIIELLIr Nt W SEMAN
1�,"2U2 Commission QiP "r- ISSi{}hi PA1459
E)GPIRES Febwary ;
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REVIEWS FRONT ZONING SUPERVISOR PLANS V ION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.