HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
J.
i
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential A/
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: — - 9 3 Z�'-O'. A5 / .a U
Property Tax ID #: U f4Cz _ I Lot No. _
Site Plan Name: Block No.
Project Name: � r_ r 4C cx ,c ; T 9
[DETAILED //DESCRIPTION OF WORK:
/ r� C. e lvl 7�- J /e -
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_„_Mechanical � Gas Tank � Gas Piping _ Shutters
_je/Electric _Plumbing _Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ __ ,rj 00 f _ Utilities: _Sewer _Septic Building Height-
OWNER/LESSEE:.
eight:
Windows/Doors
— Roof Pitch
OWNER/LESSEE:
CONTRACTOR:
Name.. t%c-ksa= �_
Name:
Address: 166e9 Q %G 0141
Company:
City: ,/�Ej,, 'efle-e-Ce- , / state: _
Zip Code: Z992 ,Fax:
Phone No. ,24
Address: j
City: i e'�I� State ��
Zip Code:3Z Fax: ; .-
Phone No 2707- -IC-t5 .2-3z:'3.
E -Mail:
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
E-Mail_6�5/�/ G, C
,,
State or County License&- . Lr&
.. Ww %.vilzai Lit, Liu I I Do ?tJw yr rnvre, d ntwrcutu ivouce or Lvmmencement 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
Name:
Address:
City: State: ~�
Zip: Phone —
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State: --
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:_ _ _
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 Assodatron rules, bylaws or and covenants that may restrict or prohibit such
structure, Nease 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_"
Sigryature;nf Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY
The forgoing instrument was acknowledged before me
this "day of 7.0/ f by
OS �a
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida J
Commissio '''"+�— DQLBH mc6* L
My COMMISSION a FF915904
REVI
COUNTER
DATE - ----- --- -----
RECEIVED
DATE — --
COMPLETED
ev. 7 7M --
Sign ur off Contractor/License Holder
STATE OF FLORIDA
COUNTY 0��%G'
The forg�ing instrument was acknowledged before me
thi day of eqA �I% 204 by
��
Name of perso making statement.
Personally Known V-"�_ OR Produced Identification
Type of Identification
Produced -
(Signature of Notary Public- State of Florida)
RRFFAXP�IPERVISOR PLANS
REVIEW REVIEW REVIEW
RANDOLPH MCDANi'I)
My COMIS
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REVIEW REVIEW REVIEW