HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q� ,� `I
Date: G1%11 Permit Number: � -1 U - 0M
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 r*P
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:..
Address: 5 yr Sf't�c�.►t7-e. b .
Property Tax ID #: 0 j —o(`LII() (9 U Lot No. -14 3�L.
Site Plan Name: i Block No.
ProjectName:,���t��(�
DETAILED"DES "RIPTION.OFyWORK:
CONSTRUCT [O N'. IN FORMATION
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:
Cost of Construction: $ 3-up
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE - ,"'
CONTRACTOR.
..J,;.
Name c,
Name:
Address: ��(3 5��., r.(�c�(1e_ L- ,
Company: �0) Qdf\ rAC--
City: 1 . P i•2,d`C — State: rL
Zip Code: Fax:
Phone No.
Address: 7,1-e— (W• .
City: P, S, L = State:
Zip Code: -149 Fax: 772 a3--0
Phone No "77a`—
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail OU¢.0 h
State or County License d
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 71LIEN"LAW .tNF4,RMATIO;N:':
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 FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTIJaE F C MENCEMENT."
Signature of Owner/ Less a ontractor as Agent for Owner
Sig ature of Contracto
icense Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORID
COUNTY COUNTY OFa
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of
20_ by
ua
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identi tion
Type of Identification
Produced 'y
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- tate of Florida
Commission No. Se I
_
IX"G�M RAHMING
Commission No. ,. ;e:;�:•., 1-ml A.PtN
275060
RAH MING
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REVIEW
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REVIEW
DATE
RECEIVED
DATE
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