HomeMy WebLinkAboutBuidling PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L(4 (a� (Zo►9 Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential
PERMITTYPE: -ArC chcav, 9-,P- ovr
V) l
IPROPOSED IMPROVEMENT LOCATION:
Address: k-
PropertyTax ID#: Lot No.r0JG
Site Plan Name: Block No.
Project Name: Si ez),, .+GL�nc��C.0
DETAILED DESCRIPTION OF WORK:
%1
SX 4110
�► S PT 3s
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
?Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction: 1_ , �5Cj Z.,
Cost of Construction: $ --Ifi
OWNERf LESSEE;
Gas Piping
Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor:
Utilities: Sewer
Name),2,Q.,n, 'rQ,(NCLLQer
Address: 11 iC (�
City: f'C 12CC.L State: �(r,
Zip Code: StARR A(ca Fax:
Phone No. :17,1-
E -Mail: 'd
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Septic
Windows/Doors
Roof Pitch
Building Height:
Name: "R INQ-J T PA 2�bq2,„ % .
Company: USAG6 N rTi oyft ..
Address:( :5W j �7 Ci
City: i Q m i State:.
Zip Code: Fax tC6-Gte-3
Phone No -7 -?L - 2< - ct(A �ci
�k
E-Mailof�(ic.e P,QSCkCz ( 1�il+a�•�ii
State or County License�C.. (8 IGT)
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
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 Horne 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 FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
5ignaturp of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO IPA
COUNTY OF I- — G1.o_
The forgoing instnt was, atknowledg efore me
this � run day of 1'+ ( 20 by
Signature of Co5�",M (��
ntract /License Holder
STATE OF FLO I A
COUNTY OF AMf'
The f r ping instru ent w s acknowledge before me
this day of Ct 20_n by
Name of person making statement. I Name of person making statement.
Persoted
y Kno n OR Prod
Type aentif, tlyn r
Produ I 1
(Sig re of Notary Publi - State o
Commission No, F� 2232
entification
Personal own.< OR Produced Identification
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REVIEWS FRONT ZON NG SUPERVISOR I PLANS I VEGETATION I SEATURTLE MRAN E OVE
COUNTER REVI REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED