HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN .MUST BE�COMPLE • FOR APPLICATION TO BE ACCEPTEDIP
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Date: t. -- 4 1 "' Permit Number: `.�05—
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F R D Pt 1111 ,.. Building Permit Application $ttE111Eo
Planning and Development Service's . . bitty 1 4 in
Building and Code Regulation Division •
2300 Virginia Avenue,Fort Pierce FL 34982 Permi in 0PdO ii@nt
g 'cif Cal*
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential St.
PERMIT TYPE: - .
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��RAs POSED IN tOVEMENT LOCATIO� � ��• > I N < �x .W� s MOS t
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Address: J. Osiodoo � 1
Property Tax ID#: 5-Py 'bO 1 - O t —? OU//$ Lot No.
Site Plan Name: Block No.
Project Name:
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Cf NSTE UCTIO INFO`RM1 TIO � x y s a r y}� � �> � - ° �N:
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Additior- k work to be performed under this permit-check all that apply:
Aechanical • _Gas Tank _Gas Piping _Shutters —Windows/Doors
/Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: • • Sq. Ft.of First Floor:
Cost of Construction:$ 2 9 0 0 Utilities: _Sewer _Septic Building Height:
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Name S- 4 ' A -"`` Name:
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Address: II 0 . IA) j1,Je13 y Company:
City:
`- (1Pine-
t - e State: ' Address: • . .
Zip Cod34. Fax: .City: '..'.' - .- : State:
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Phone No. 1 Z - ('_;( Y6— cl '2—Z(-1 .: , Zip Code: .' Fax:
E-Mail: .CJ.-:_P-hone leo-1•111 - - - •:
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.
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IS OP 'EM : ',.' ,CO VST UCTI l (V LAIN INFORMATION,Ak Y " ,•v11 • h „r� � "� ~'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
. Zip: Phone Zip: Phone:
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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.
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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.
Ili consideration of the granting of this requested permit,l 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'l
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 1 .
commencing work or recording your Notice of Commencement.
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Signature of Owne Lessee/Cont - o as ,gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF :i , ,_ COUNTY OF
The forgoing instrument was acknowledged.before me The forgoing instrument was acknowledged before me
this I'jday of _ ,204"by this day of ,20 by
Sad- d (gut- , , c. .
Name of person making statement. 1; .1 Name of person making statement.
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentificationType of Identification .
Produced •� "- Produced
p...A/ 0 a,7 __________ .!
-(Signature of Notary Publ c-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. , 1,illt,,SSeal) ELLEN VAUGHVCom ission No. (Seal)
AApf, ;State of Florida-Notary Public ' • i•
1 *= Commission # GG 270079 •
s"�1!M"ii a Ny Commission Expires .• •
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REVIEWS FRONT -_- ._. ";`022:; - 1'S VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW • REVIEW
DATE . -
RECEIVED -----•-- .
DATE "
COMPLETED
ley.9/26/18 •
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