HomeMy WebLinkAboutBuilding Permit Application INF r MUST BECOMPLETED3 r /rV�6("LOU91
All APPLIC P FOR APPLICATION TO BE ACCEPTED LEjU
G Permit Number:
Date: 1 I 1
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�'� ` `'+� Building Permit Application smutty °1B.
St c9 Depa
Planning and Development Services e c°4 rment
Building and Code Regulation Division `x,
2300 Virginia Avenue,Fort Pierce FL 34982 Residential Phone:(772)462-1553 Fax: (772)462-1578 Commercial
PERMIT TYPE: ` _
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Address:
✓11'ti r,r Lot No.
Property Tax ID, - —
Block No.
Site Plan Name:
Project Name:
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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:$\\ "',,� - k Utilities: _Sewer _Septic Building Height:_
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Name r.p III � Name.• �'
Addr ss:` 4i " en D1 ( Company:1 � dt 1�r '
City l' " 1 � State: Addre s 1 h.
Zip Code: Fax: City: l e tSttate:
Phone NoTT)1/� d 1 Vr"�`' ."F)0.1La
Zip Code: CA Fax 1I2"t.a13
E-Mail: Phone No-11Z.- '1 3-- " -L� is
Fill in fee simple Title Holder on next page(if different E-Mail C ►%p,r \L\ 1 t, �- 11`l
from the Owner listed above) State or County License( PIC \ \LA'A 5CV
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,SO0,or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: i M Not Applicable MORTGAGE COMPANY: ____Not Applicable
Name: Name:
Address:
Address: State: li
City: State: City: ,
h
Zip: Pone:
Zip:_ Phone ,;
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: _ Address: !'
City:
City: II
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 Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conict 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 FiNANCIINC, CONSULT
, WITH YOUR LENDER OR,AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Own:r/ ressee/Contractor as Agent for Owner Signature o C ntractor/License Holder
STATE OF FLORi 0A ,' �f" STATE F FLORIDA ' Or:
COUNTY OF \ A C__ COUNTY OF ,,, ke
The rgoing instrunietit was acknowledge before me The f oing instr ret wawa nowledge before me
this G day of ' i'I"it'.. ,2011 by n this ay of 4 /t` ,20 tti by
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Name of person making statement. Name of person making statement
Personally Known , OR Produced identification Personally Known OR Produced Identification :
Type of Id:• iffation , , Type of I entif ation
Pruced + i\l �_ 1I ` t n
Produce 33d':v ( i%' ?
C.
SINN 1 1 i1 a 7 Dr d41
(Signature of Notary Public- a'�F,q,e ori.- S • ature of Nota
TNERlNE' MILLERS rYPublic-Sta --• --•-•••.
�^ -, %state of Florida-Notary Public l so�I"Y1tb� wCATHERINE MILL'R
Commission Not: _IIE: .M!':, •° CeM Ission tf GG 27331 ;^ 2'� P ai° �4"' $ofFlorida;Notar-Fibtic
,� { ' fan mission NcS� t,, • ,,� lnmission a GG 213: t 5
'a °'o My Commission Expires ' '
.,o.f4. 43'I .�tera
,timid November 01,2022 40,,,}.��` My Commission Ex'•ii!S
��"':i n" No ember01,20'i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ,
DATE
COMPLETED
ley.2/7/19