HomeMy WebLinkAboutBuilding Permit ApplicationNil APPLICABLf INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z % q Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
.2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
DETAILED DESCRIPTION OF WORK A
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CONSTRUCTI"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 _ Roof Pitch
Total Sq. Ft of Construction: pl Pf Sq. Ft. of First Floor: 0 [ ON
Cost of Construction: $ ! ovc, co Utilities: —Sewer _Septic Building Height:
Name f'd�
City: p SG State: �'L
Zip Code: 3 * `I S'.3 Fax:
Phone No. 7?2- !it?/— yS9 O
E-Mail: R'L' ka-k '�o C'C>m
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR`
Name: Miehd*,01 �C�%c1,rcP
Company:--Cnr1oy4:rr�&*i CoorfircaGf2 r.�Q
Address: P d- b o>e 1 2 `75 7
City: rll-. Ae;e-G State: ZipCode: 3-0 97 7 Fax:
Phone No '772- 57 9i eW
E-Mail rnwoe, l drop 1�lnnoya. o�'i Lo, �
State or County License /;S/ / 4 / a
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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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 OWN . YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR 17
EMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED OB SITE BEFORE THE FIRST INSPECTION. IF YOU�TEND TO OBTAIN FINANCING, CONSULT
WITH YO Oft AN ATTORNEY BEFORE RECORDING YOUR,XOTICE OF COMMENCEMENT."
Si ature 0 r/ Lessee/Contractor as Agent for Owner
' nature o icense Hol r
OF FLORIDA, P _ -
&1act
STATE OF FLORID �
4 1- Ae
CTATE
OUNTY OF T e
COUNTY OF -
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this' day of /i�lCc,C/ 20 " by
this%day of M 20/� by
Name of person making statement.
Name of person making statement.
Personally Known '-Z OR Produced Identification
Personally Known _ Imo- OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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A
ignature of Notary Public- State of Florida)
nature of Notary
Commission No. v*"� JAMESPIfMy �}11;GTONAR.
��'�.LN-1 JAMESAWETHINGTON,JR
Commission No.
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DATE
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