HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO /MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "/ 7 '/ / 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 _
PERMITTYPE:
PROPOSE049q2—
D�IMPROVE
8� MENT
LOCATION: ,/
Address: 7 2— P)CO /�
S /�-O,46 4::n09-:4::n09-:J0 � PI G)Lce 34945
Property Tax I.D#: Lot No.
Site Plan Name: Block No.
Project Name':
DETAILED DESCRIPTION OF MM.
L O lz- U )( - 2l`I —70 /L CjcP-O� /V►rvl fl'C
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CONSTRUCTION I FORMAT ON:
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: $ -:5-0 Q Utilities: _Sewer _Septic Building Height:
01NNER-j1L�E-��S�SEE: CONTRACTOR:
Name 5_1)4t*L'3 e 6_ Name:
Address: I 'S i I CW k3QW4-Ve_A_ JZO Company:
City: t0C'-A-5-1 StatePt Address:
Zip Code:Z>4!3 4 S Fax: City ._d._,.w•. r_> _: ,,� ,:_ :.
,,, State:
Phone No. � 2 Z-Z�o7 � (o Z3 ::�} Coci'e, .•.,:.� �_ :i ' s l`'
p:.; y,. . _ ;,:Fax:
• i1 Yi.,' � �r ��•
E-Mail � A'�a. , ;F:hone:No•`'���' -- 4'�
Fill in fee simple Title Holder on next page if different `. ':E.=IV aib-•..s-=w' r=.�:= <:.-;: :
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.
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SUPPLEMENT L CONSTRUCTfON Lf�N LAW 1�NFORMATIO
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
WIT ENDE AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ignature of Owne /Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY COUNTY OF
OF Vr
The forgoing instrument was acknowledged before me
The forgoing instrument was cknowledge before me this day of 120 by
this day of 20 by
, �Q9Q�S1 Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification` Type of Identification Produced
Type of Identification
Pro ced
(Signature of Notary Public-State of Florida)
1
(Si at re of Notary Public-Siate of Florida ) Commission No. (Seal)
Commission No. (Seal)
<islY:; UWgWNAING y 14b,.
;+r MISSION#GG 27 060
REVIEWS FRONT 1W610 E,W W 22 PI ANS VEGETATION SEA TURTLE MANGROVE
COUNTER UWarwritREVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19