HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE I Fd YUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i-
Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division
230+0 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 457-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCA O
Address; .--f L
Property Tax ID #: _oo ctq—
Site Plan Name:
Project Name: ,� I-,� C"
DETAILED DESCRIPTION OF WORK:
-� uIi acf A I-, . (-I- It') IFnQ
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
,Mechanical _ Gas Tank , Gas Piping — Shutters _tom indows/Doors
Electric Plumbing _ Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.. of First Floor: ! t
Cost of Construction: $ Utilities: _✓ Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Give
Name
Name: V,
Address; a'
Company;•'
City: —..�i�.
—State: Fl—_ Addr1E,
_ Zip Cod Fax; Cit h
Phone y: State:
Zip Code:��7_ Fax:
E -Mail. b �G�► _t-� ;'!1 C _C hone No
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 RECORDER 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
nim.,.
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zi • Ph
Name:
Address:
City_
Zip: Phone:
te:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
i7• one. Zip: Phone:
_ I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noo work or installation has commenced prior to the issuance of a permit.
wthiichis intcontfli t wimakth any applicable HomeaOiwners Asssociat+o rules, y awill ws oize r andpcovenants holder
build yrestri subject oroh bit 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 8uiiding Cedes 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, wails, 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
A —R ^ ORE RECORDING YOUR NOTICE OF COMMENCEMENT."
WITH YOUR LENDER OR AN ATTORNEY BEFORE - _
re of Owner/ Lessee/CoWactor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this,/ day of 2n— by
Name of person making statement.
Personally Known OR Produced Cdentification _
Type of Identification
i (Signature of Notary
Signature of
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this t _ day of '. 1 20 1 by
Name of persd'n making statement. v _
Personally Known
Type of Identification
Produced
(Signature of Notary Pu
mission No.
PLANS VEGETATION
REVIEW REVIEW
OR Produced Identification
SEA TURTLE MANGRO'
REVIEW REVIEW
�* Y �M+�RVIV It RIES JR
Commission No.
G�,�
i n ry 610MSGGN37F2
Expires Cr -31.2022
Sanded Thrcu9^ r"8 9ot8r
LVCommission
IF
REVIEWS
FRONT ZONING SUPER i
COUNTER REVIEW REVIEW
DAT£
RECEIVED
DATE
j
COMPLETED
I
Signature of
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this t _ day of '. 1 20 1 by
Name of persd'n making statement. v _
Personally Known
Type of Identification
Produced
(Signature of Notary Pu
mission No.
PLANS VEGETATION
REVIEW REVIEW
OR Produced Identification
SEA TURTLE MANGRO'
REVIEW REVIEW