HomeMy WebLinkAboutBuilding Permit Application All-APPLICABLE INFO /MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: l0� `� Permit Number
RE IEC VED
JU,N XS %oi9
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Building Permit Applic 1OC,?ic G219MY, Ptrin►tting
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 lO
PERMITTYPE:
PROPOS D 9WOURMNM LOCA 10
Address: �� (C,�C�C��j— T �� ��✓C C, ( 3����
PropertyTax ID#: O a- `^d��- c a A)-- 0C)n--y Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE�SCR+PPT ON QF O KK:
CONS RUCTION LNFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator 1/'Roof Pitch
Total Sq. Ft of Construction: S(W Sq. Ft. of First Floor:
Cost of Construction:$ �04W(D Utilities: —Sewer _Septic Building Height:
OWNERjLE�SS WE: CONTRACTOR:
Name a Name:
Address: 4eKd1r4?1TA- 0.c/– Company: Azp dG&n�
4
City: eve, State: Addre /0"7.8 .gu
Zip Code:�y�C63, Fax: City: rT 4 f(ie-t-e— State:
Phone No. Zip Code: 3(-/'797 Fax:
E-Mail: Phone No 7y 'FIS 6
Fill in fee simple Title Holder on next page(if different E-Mail 11 1;211&
from the Owner listed above) State or County License &&/,?33170
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
W11HAUMILE1111DER OR AN ATTORNEY BEFORE RECORDING Y UR NOTICE OF COMMENCEMENT."
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Sig ature of Owner/Less ee/Contr for s Agent for Owner Signature of Contractor/Licen Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sir_ 1.0 c-\";?, COUNTY OF 3)r.,
The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of V 4\-1z ,20\1 by this \ day of ZV ylt . 20_k!� by
tLd �o,•��. Z,,\-e,�- �d\b�� R0 1.1g1A
Name of person making stateme t. Name of person making statem nt.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identific ion
Produced L Produced L--
(Signature of Notary Pu c-State of Flori D� U0yps�� GO�?2R u(S ature of No -State ' �rt#GG6�
Oe bet 9 2e ��e s �.{ COPh S:December 2 rourilers t
Commission No.�oa. ,, '0�3 $� C u�` 1:- `2. *ar3E7(PIRE U„a=fJ
;r.•( 5'. gyp..ab,C ` mission No. dZnniFlola
•;r? 2 -.I -- on e
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REVIEWS FRONT , SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 21 1.9