HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number,
Building Permit Application
Planning and Development Services
Building and Cade Regui€ation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-553 Fax: (772) 46e-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION.,
Address. 0-) �Ck
Property Tax tD #- S'A SLD, — r�i�a � �- ��� �� � Lot No.
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
u' C_ -C
CONSTRUCTION INFORMATION:
Additionaf work to be performed under this permit -check all that apply:
_Mechanical Gas Tank —Gas Piping _ Shutters
-<Flectric Plumbing —Sprinklers Generator
Total Sq. Ft of Construction: f
Coast of Construction: $ 1f� U 0
Sq. Ft. of First Floor: _
Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r
Name:__ ,.
J
Address; �`��✓:rte-
Company: t�1Mc
City: _ ; ", State:I
Zip Code:Fax: ry6(A.
Rhone No, -? . — ccs.
Address. L-er
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City:
Zip Code: 3Lt,32 Fax:
Phone No'J.. CU..
_
state:
1�))A
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above) I
E -Mail I? e ^ i,
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State or County License
- —sue ul culi5tc ucirun m yrauu or More, a KtLUKUtU Notice of i:oMtriencement is required.
If value of HVAC is $7,500 or more, a RECORDED mortice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City. State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER. Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 author;?e 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, 1 do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and 5t. Lucie County Amendments.
The fallowing 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 !OB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY (BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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�' Lure o race License Holder
Signature er,' Lesse o *�{ as Agent for t7wne
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
I COUNTY OF Sf L��ct C
The forgoing 'mstrumerit w s acknowledged before me
The forgoing instrum nt was acknowledged before me
this day of ri 20 by
this � day of rt 20-6 by
I
LJ cf-zl6
Name of person malting statement-
Name of person making statement.
Personaily Known V OR Produced Identification
f
i Personally Known if OR Produced Identification
Type of Identification
Ty of identification
Pr uced
Pr d ed
( fig ature of Nota
v pr; JEAN AM T VICTOR
(Sign Lure of iN ...... JEAh At+hl S CTO R
a l�;": Notary Pcsbiic -State ai Firxida
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(Ca fission Pica :;• �� Naiary Public 5tateot Florida
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My comm. Expires flee 1 ], 2022
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of My Comm. Expires Dec 13, ZU17
h National Notary Assn.
...ti6rSai Notary Assn•
REVIEW'S
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PLANS
VEGETATION
SEATURTLE
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COUNTER
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RE=VIEW
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REVIEW
DATE
RFCFIVED
GATE
COMPLETED
ttev. 2/ 1119