HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED P011,03
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Date: Permit Number: G "` 0/ • 03 (S
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.
PERMIT TYPE:
P M7602 D IM'PRO 'EMBNT LO AT ON•
Address:
Property
Site Plan Name:
Project Name: _
9
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: q aO+"Sq. Ft. of First Floor:
Cost of Construction: $ -7 O`D O Utilities: —Sewer —Septic
Block No.
U15
_ Windows/Doors
Roof 10. I itch
Building Height:
0 NERJLE�- ,SE5 1C�NTRACTC�7R:
Name 0 iZ-L; LL V
Name:
Address:t S • J% S�
Company:
,s�
city: 'r t P �C J State: FL
Zip Code, 3 46lC(7 �Fax:
Phone No. � 7 4- .- 3
Address:.,
City.:.. , _ State:
Zip Code: Fax:
Phone No
E-Mail:Jrr<,'J1I VL- L/�
'TV►� ems✓ CgHL rC_0YK
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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 Applica
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
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 AJY ATTORN Y BEFORE RECORDING YOUR.NOTICE OF COMMENCEMENT."
tig�nuk of Owner/ Les ee/Co ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA "
COUNTY OF
COUNTY OF
The fo oing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 204 by
this day of 20_ by
��r��P �YloYe I a•
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif�eation
Type of Identification
Produced
i
Produced
(Signature of NotaJPub c °6ltmid�st) Florida -Notary Public
Signature of Notary Public- State of Florida*=
Commission # GG 207484
Commission No.11 OFf�� � M mission Expires
����mn2 12, 2022
ommission No. Seal
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
OWN"