HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: R%OX-'• 040
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia'Avenue, Fort Pierce FL 34982 L/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMRR'OVENI'ENT-LOCATION. .
Address: 51 �► (� ^`C� 4.� e\ �_ Pi"ev eR-
Property Tax ID #: CSco - O Lot No.
Site Plan Name: Block No.
Project Name:
DETAILEUDESCRIPTION OF WORK
CONSTRUCTION" INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator oof Pitch
Total Sq. Ft of Construction: ?�= Sq. Ft. of First Floor:
oU
Cost of Construction: $ /D �� Utilities: —Sewer —Septic Building Height:
01NNER/LESSEE =
CONTRACTOR:
Name cln 2
Name: Av�rQ �cl
Address: S-1V
Company: e `k✓L2 A
Address: "l' , _30 liken
City: `k IiP<<eree tate: _(
Zip Code: `�T'262 Fax:
City: Q A S4 lut-e - State: i
Phone No.
Zip Code: Fax:
E-Mail:
Phone No -i-M 9.60 gS6S
Fill in fee simple Title Holder on next page ( if different
E-Mail S lint— Q `4,9hW . mty\
from the Owner listed above)
State or County License (33 11-10
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.
v6bPPLEM'ENTAL CONSTRUCTION
LIEN LAW INFORMATION
4 �
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. IF YOU INTEND TO OBTAIN FINANGNG, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
W
Signature of Owner/ Lessee/Contr ctor s Agent for Owner
Signature of Contractor/License kqleF-
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF S )�,kkcA Q
The forgoing instrument was acknowledbefore me
The for oing instrument was acknowledged before me
this' day of 2 by
this day of iz , 20_a by
Name of person making statement. QII
Name of person making statemen .
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Prod ced
AnJS4 44,1 gly unm Z& Or K
(i at re of Notary Publi State of Florida)
gn ture of Notary Publi - tate of Florida )
Commission No. LASH p( INGRAM-RAHMING
Commission No. ��""•�' N _ __ _ M SS O ING* ING
c 75M
MY COMMISSION # GO 275080
2022
�: :•e
EXPIRES. December420, 2022
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OFF „•
REVIEWS
FRO
OR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19