HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c C�
Date: Permit Number:
o
— RECEIVEp
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JUN 1
2
0
19
BuildingPermit A
licatio
Planningand Development Services T' 6b�ip t~ount
Building and Code Regulation Division Y� Permuting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
a
Address:
Property Tax ID#: -3a �d ' dd a.y� d00 -q Lot No.
Site Plan Name: Block No.
Project Name: { ,�/,N? c-
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Additionalwork to be performed under this permit-check all that apply: ,
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
_Electric _'Plumbing _Sprinklers —Generator —Roof Pitch
TotalN. F�Construction: 2 S l r Sq. Ft. of First Floor:
Cost of Construction:$ 5, l�9 Utilities: —Sewer _Septic Building Height:
j~ sW 4
Name 7iw Name: F}vS/-fh RGrI�P�'
Address: �Z// 3n��-h� men .�,�- Company:_/ uv`ler� Fer�C,n� $p� :'fya'15
City: F-�" ,�l�}iP1 2lefl State:-r Address: 2 J6
Zip Code: Fax: City: UcCA State: fL
Phone No. Zip Code: -6 °lC,Z Fax:
E-Mail: Phone No 7 'Sn —�� 7(,
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.
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 NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF k • t-0���
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
thisA"S day of V wk, 20 by this day oa 0 Ty4_ 20A by
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 lr
(Signature of Notary P ic-State of FloriNS (Signature of N - epi iRiJ1 ��3iV'e:^`.`� 1.;
RII; ?3 vP a "3 i;'
Gv a j ?o. '=
_My
COMMISSIO
Commission No.�d 3 QrrJi��SsiOl Lr 16 Zn2B ,sy; ommission No. IRES:Dec raj' 'i'`d 1
O��Rmb lieu dem itz a° dedThru WOtary Puhifr�ndeM1�2ii2 Ih
=2°' k"z EXp1R ISotanPub / " Bon _ «;.Y 5,.�
REVIEWS FRON G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT E REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2-1