HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �sar C( (� Permit Number:
Building Permit Application
Planning and Development Services ��Ot� �64•,,,�''S
Building and Code Regulation Division -4 QVC)
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residentiab, V
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 4 I l`c4 /nT. a o d Sti l 17
PropertyTax ID#: 3 11 / —S1,Y— 000 7,6d U,.i Lot No
Site Plan Name: R I V C 12 PA�Z I< J n T-3 Block No. 3
Project Name:
DETAILED DESCRIPTION OF WORK:
, V, e- - -h K, V G1N )C N
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 Roof 2 Pitch
5-0
Total Sq. Ft of Constructio).n: �_�Cf ��Gsd �J Sq. Ft.of First Floor:
r
Cost of Construction:$ �//S''>C Utilities: —Sewer. _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name a5- d Name: v`,-/ so It S
Address: Company: S'�/iS -
City: dr-4- -G(4- zct� State:FL Address: Iz,31�
Zip Code:3V ISc3 Fax: City: mei-e State: ��-
Phone No. Zip Code: ',32143.3 Fax: 77z 4,oQ.
E-Mail: !v)a4-0y'eg -tkwl « Phone No
Fill In fee simple Title Holder on next page(if different E-Mail _SU
from the Owner listed above) State or County License-"CCG
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.
i
SUPPLEMENTAL CONSTRUCTION LIEN .LAW INFORMATION:
DESIGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: ` Address:
City: tate: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY Not Applicable''
Name' Name:
Address: Address:
City: City:
Zip: Ph e: Zip: Phone:
OWNER/CONTRA(:; OR 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
O WARNING TO OWNER: YOUR FAILURE TO RECON 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.7
areof caner/ essee/Co tr ctor as Agent for Owner igna ure of Con actor/license Holder
STA E OF FLOR ST E OF FLORR
COUNTY OF COUNTY OF p
The fooing instrument was acknowledged before me The for going instrument was acknowledged before me
this �� day of !IQ 206 by this IU day of -�Sk)rpt .20Z'q by
6CIVLC �
Name of person making statement. Name of person making statement.
Personally Known / OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
r � �
(Signature of Notary Pu m"Mo (Signature of Notary P blit
` 281669 co,
Commission No. *'- My�SSI0N9GG �ON1kCO28168•' g;gpn1A,2MAJANO
023 Commission No. I� y1p�U(IdelwlllBlS 4,4O1�gdTtMUNoteyPll*U
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
RECEIVED
DATE
COMPLETED
rev.