HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ �\16\ Permit Number: l
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Budding Permit Applicati1,nrr, Prmitvn9
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
PERMIT TYPE: -rCOJF - Sh;n(j i�
Address: tJq 1 L a"in t- _TIzc t br+ (' Hq KC9
Property Tax ID#: ,-A' CbA LVID D !Q)(J 000 K Lot No.�
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
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YCQVSTRUCT�ON INFORMATION x w ,?rf az r„' �'�" � r :
,✓ s�.8 s" .d:'Y.b4 ..,e,. ,L, ..f., -'� ,?$. � $.,..."�'f � 3,-,, x art�n�4bY
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator -w--' Roof Pitch
Total Sq. Ft of Construction: 3' Sq. Ft.of First Floor:
Cost of Construction:$ tl Ol Utilities: —Sewer —Septic Building Height: _
�OVI%NER/LI=SSEEi A �� t CONTRACTORr,
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Name T)O(1414 V&1 rk_4,e-- Name: rz �� �
Address:4eO,� ro i o-n f I7� . Company: 0' ' lhz)-Fz, xl
City: 42a P1,-e l%(_ State: Address: 190.5 SSU SwAn, Mae& V�,
Zip Code: Fax: City:?&- --, Lua & State:
Phone No._'7'A -�03 CD3 6 Zip Code: Jug/9” Fax:
E-Mail: Phone No °7"79•-"3NLI- r7_1
Fill in fee simple Title Holder on next page(if different E-Mail,50 u Cc1 q h a0.(°J1'r\
from the Owner listed above) State or County License ° d
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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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. W YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT"
Att-1 AA�C�
Signature of Own r/ ss a/Contractor as Agent for Owner Signature of Con ctor/License Holder
STATE OF FLORIDAC-', 1 G, STATE OF FLORIDA (,) Q
COUNTY OF �T C u ,(�, COUNTY OF C36' 11�4C�V
The Igrgoing instrument vyas acknowledged before me Theforgoing instrument Was acknowledged before me
thi day of AWt I 20� by this'T day of )q0P11 .26 6 by
cNl cjewreq
Name of person mdking statemerit. Name of person ma
Jing statement.
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public- tate of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED ����, CONST NCE PROUL -phi QTA 010r.
ev. ;_° %State of Florigil-NMAIr ;�o�YP„a%
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Commission#09 20E320 -State of Florida-Notary Public
My Commleslon EupplM Commission #00 268328
September 10, 2922 .; �� o�Ao' My Commission Expires
September 16, 2022