HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE (INFO/ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `) ^ l Permit Number: A'15 -o 00
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PRQP.OSED IMPROVEMENTLOCATION
Building Permit Application
Commercial Residential V
Address: (OD AJ SA '68 9,tY P.,e__ E l 3 fi 1 q 7
Property Tax ID #::24043 -- �3 03 - 00c)9 - coo -- ', Lot No.
Site Plan Name: Block No.
Project Name:
CONSTRUCTION'=INFORMATION
Additional work to be performed under this permit -check all that apply:
Mechanical
_ Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
Sprinklers
Shutters _ Windows/Doors
_ Generator L--Aoof Y Pitch
Sq. Ft. of First Floor: / 00'Sr
Cost of Construction: $ --I S9 c-'O Utilities: —Sewer —Septic Building Height:
Name 3
Address: W-1 0 si
City: 1`4 R-erup— State:
Zip Code: V '-Ace L- -1 Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company: 1/tC_ �nnA
w Address: 0-13 S��cx f2 SJ
City: Pod 54 lcli-e._ Stater
Zip Code: 340 6-7 Fax:
Phone No'7-7a L9Id0 e1SbS�
E-Mail c,r, Cf -1 44Uy ,. eAw`
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.
SUPPLEMENTAL CONSTRUCTION LIENIAW INFORMATIO I
Name:_
Address:
City:
Zip:
EER: _ Not Applicable I MORTGAGE COMPANY:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Narne:_
Address:
City:_
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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Co r or as Agent for Owner
STATE OF FLORIDA
COUNTY OF �A oa9:y 11
The orgoing instrument was acknowledged before me
thi Q day o,86
-, 20_p_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Sig atu otary Public- State Florida )
Commission No. Rpti1MING
SHAN �#GG21501i0 " •:*pY GUyfiL � ..MIUISSION nM
CO2f 0_k2
Signature of Contractor/Lice se Ider
STATE OF FLORIDA
COUNTY OF Sgk. ��l
The forgoing instrument was acknowledged before me
this � day of �9, 20la- by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
gna ure of Notary Public tate of Florida
Commission No.
-RAHMING
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19