HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Q 112 f znn Permit Number:
COUNTY
F L
O R I
D A —
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
PERMITTYPE: �� S
Address:
Residential t
Property Tax ID #: SLA V i —Scn r b_41-7 - norin Q Lot No. \ , 19_
Site Plan Name: 61 A- Block No.
Project Name: (•1nylaoo"
DETAILED DESCRIPTION OF WORK:
._"
CONSTRUCTIONN INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping VShutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: p n�
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Names 6 "Wu
AAO U C S
Address: 1?T ft)e i �.bP r% t' •121 kJJ
Company:
City: Q_-r S> C (.1 Q Stater
Address: b gT
Zip Code: Fax:
City: d P State:—U,.-
Phone No. �O U�
Zip Code: q� Fax: 0�10�110�•�(f1
E-mail:l��rYbP(- 409
Phone No 'SW r-) Lio:
A 15�;2
Fill in fee simple Title Holder on next page ( if different
E-MailML&elY>Git
from the Owner listed above)
State or County License '
If value of construction is 5Z500 or more, a RECORDED Notice of Commencement is requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: _ 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 Home Owners
conflict with any applicable 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 YQUIR NOTICE OF CO MENCEMENT."
Signature of Owner/ Lessee/Con VC as Agent for Owner Signature of Contractor/Lice Holder
STATE
OF FLCOUNTYOFORID (•�YOQI`�C1m�Q0 OYOFORIDA��
Q, COUNTSTATE
The fporgQing instrument was acknowledged_ before me The forgoing instrument was acknowledged before me
this ay of f 20 by this �' Tday of t 0 . 20� by
Name of person making statement. •
p g Name of person making statement'
g��,�•c;
Personally Known �� OR Produced Identifica Personally Known
ci OR Produced Identifica cam'►' z
Type of Ide tification 3 T Z Type of Identification °
�
Produced Dn `Ip �[ 1�5� 7 Z m 3 Q Z Produced' eioa 0XI Jer-11- l l 3 3
a zmvz
22��'b��y(y"Q
W 7 N h
G1 m / Ll a O
O
(Signature of Notary Public- State of Florida) ti s (Signature of Nota Public- State of Florida)
hCommission No. �� !�(Seal) Commission No. (Seal)
Li
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 217119
1 /4/2018,
Florida Building Code Online
Professional Regulation
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F
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Manufacturer j Validated By 1 Status
FL389-R9
History
Revision
American Shutter Systems Association, Inc. i John Henry Kampmann Jr. Approved
Category: Shutters (941) 922-3854
Subcategory: Accordion
Approved oy LIM K. Approvals by Ot3PK snail be reviewed and ratified by the POC and/Or the commission it necessary.
Contact U :: 2601 Blair Stone Road, Tallahassee FL 32399 Phone: 850-487-1824
The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic
mail to this entity. instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. -Pursuant to Section
455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have
one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal
address, please provide the Department with an email address which can be made available to the public. To determine if you are a licensee under Chapter 455, F.S.,
please click here .
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