HomeMy WebLinkAboutBuilding Permit Application f
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
-� Permit Number:
RECEIVED
® MAR 8
Building Permit Applic tion
T. Lucie County, Perml
Planning and Development Services tting
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 IM_
PR'OVEIVILW LOCATION
Address:--1 ,5 C:(D C, Y,u3 j E)'
Property Tax ID#:1 .�%( - Q�S- S%cl1 - �'��;'`j Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED=DESCR{PTION OFWORK.:
CONSTRUCTION;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 Ileo
of Pitch
Total Sq. Ft of Construction: ,>0 tag Sq. Ft. of First Floor:
Cost of Construction:$ , C6�� '0 0 Utilities: —Sewer —Septic Building Height:
OwNER/LESSEE CONTRACTOR
Name YSze, Name:
Address: 5`o lti n - -c. C. Company: I-.z
City: (7 t i tt� . State:_ Address: !c V3 <
Zip Code:'3 5 ( Fax: City: P v Ck S c;n k t.c State: �Z
Phone No. Zip Code: 3 `-( -7 Fax:
E-Mail: Phone No '�"2 �- -J b O S 5
Fill in fee simple Title Holder on next page(if different E-Mail S k I t�, fi\', L, ic�u. c_'
from the Owner listed above) State or County License LC-C t
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 MORTGAGE COMPANY: _ Not Applicable
I 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
h
structure. Please consult with your Home Owners Association and review your deed for any restrictions wich 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 COMM CEMENT."
Signature of Owner/Lessee/ on ractor as Agent for Owner Signature of Contractor/License Holper
STATE OF FLORIDA � r�6-. ^-, STATE OF FLORIDA
COUNTY OF �Qlf_6" 'Y.�. COUNTY OF 1 u I-�i(IJ11a
The for ain instru t was cknawledgle
jbefore me The oin instrrurrX }nt was acknowled a before me
this Y of_ _,20 ► L by this day of 20 by
Name of person making statemenfi Name of person ma-kinng�stateme
Personally Known V OR Produced Identification Personally Known Y OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of tary Public-State of FI�V404, BRANDYMOORE (Signature of 00 ary Public-State of Florida}
('2&3 ! *.'rvo
Commission#OG 14 839 cMtt,!'Wt� BRANDY MOOR
Commission No. 1Expires May 9,242 Commission Na. I} Commisslon#GG 10
_ ' BondodThruBudgetNOWYS nkeo u} v� ExplresMay9.20il
-' r"'11� BondodthruBudgotNoury
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
Rev.2T77B