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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: '. A 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 PERMITTYPE: NWROMIp"O'RO O OM17AM Add ressSIV-1 �dA -�Cff -t����� �7- � t LC, L. 3QG�;-1 Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name:��( �(` �-c,( n CenL,F !3 ©0G«RIPTION QF WOR AJ(1L VPJ n(AIC I k -(0 4-1 I t4e �-,Mr) 0 s J S� F e LL c yu j e I (D-Peel f LCCIT s eOLflI'tf ni ad� CONS TIO INF' MA GIN: Additional work W 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: 00 Cost of Construction: LOS Utilities: —Sewer _Septic Building Height: OWNS L� CON ACTOR: NameQD%( 4. Ue Rirflk 0.10C 0 Name: Address;S27;4 muinI U�U, P,-er Company: City:-1E.�• rt1r;t State: Address: Zip Code-.?L1 SISI Fax: City: State: Phone No-�na P l-ISS(v Zip Code: Fax: E-Mail: Ms- h rr--) Phone No Fill in fee simple Title Holde 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 CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: Not Applicable 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 COMMENCENT MAY RESULT IN YOUR PAYING TWICE FOR IMPnOEBI NTS TO YOUR PROPERTY. A NOTICE OF COMM NCEMENT MUST BE RECORDED AND POSTED ON THITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:' Rev. 2/7/19 Signature Owner/ L see/Contractor as Agent for Owner Signature of Conttactor/License Holder STATE F FLORIDA STATE OF FLORIDA COON , OF COUNTY OF �. The forgoing in was acknowledged before me The forgoing ingtrument was acknowledged before me this day of 20 t'\ by this 4 day of c 20\c\ by Name of person making statement. Name of person making statement. Personally Known�.- OR Produced Identification Personally•Known OR Produced Identification Type of Identification Type of identification Prced Produc �-�7, J, - r � (Signature of Nota �tVIIRUEIUIP (Signature of Notary Pu BLIG STATE OF FLOMDA Commission No. a GGJ8W1� Commission No_ 'STATE W1,914 A 914 4'QE JgA Expires 2/1412022 1 $ F�cpirss 2I14/2022 Cxpire REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 2/7/19