HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I ( ®� ®�✓
Fion
EIVED
0 9 ?_099
Building�Permit ApplicaPlanning and Development Services . ucaCownty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential'_
PERMIT TYPE: �,�,; -�
PRpgo_S
SED 11. ' OUEMENT Lt?CATIO
I
Address: 2;1 1)0.-'a 1
Property Tax ID#: � ' �.f� C2 004) A) Lot No.
Site Plan Name: Block No.
Project Name: CIU � SC_A
DETAILED DESCRdPTION 0 WOR+K:
° -I--o bre Q)Lvj-
�QAITRUCTIOI`� I: FORM TIfJN:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutter's _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator —.Roof -.Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1 d d . Utilities: —Sewer —Septic Building Height:
OWNER/LENS- CONTRACT(JR:
Name ��z l��lvL�O � t Name:
Address: '_2,'1DZ-1�:)or- Compan `.
city.�1(a—S17 L_,to-Gt-e_ State:�L Address:
Zip Code:3 4 q q�), Fax: City: State:
Phone No. �'1 orl�.oZa "' CtO CIO Zip Code: Fax:
E-Mail:�QN.S'Z%vl&eC' 0,/—J (�D (z ry)2m Phone No
c
Fill in fee simple Title Holder 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.
SU�P�LEM i�TAL CONSTf�UCTION EN W INFQRMA 1+C1N:
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Nan k 11 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA n ` ' Cw r1 STATE OF FLORIDA
COUNTY OF Uy���.Lxc'I Z COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 's\ day of C► 203� by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Xi Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 7�"L-tD L— Produced
(Signature of Nota "( +$tate OtOMW,I)EGIVENS (Signature of Notary Public-State of Florida)
_r MY COMMISSION#GG 022023
Commission No. `'(y F
[RES: ��s' _ Commission No. (Seal)
FF;,, ru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 9/26/18