HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((��
Date: Permit Number: 1 q 0 q
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
PERMIT TYPE:
"PROPOSED IMPROVEMENT LOCATION:
Address: is • �C1� /L ,/ '� %�1 /dE r�
Property Tax ID#: 7 sO�Z,4�'Oy ���y��6D 7 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED -DESCRIPTION OF,WORK:
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 Pitch
Total Sq. Ft of Construction: /� Sq. Ft. of First Floor:
Cost of Construction: $ � , S 6 0, 00 Utilities: —Se wer _ Septic Building Height:
OWNER/LESSEE: : ,
:a
;,CONTRACTOR:
Name %D,/.t. DPa u,- s cc %crI's A1JgP S71'
Address: / -PA/ S 4j►d,`on ,?Q�r,z �n ve
Name: 4-1ift/ Al
Company: Z/m &04,/7 e yL C-
City: -i r/,l e,7 47ear, t State: 41-
j.��uz�r1
Address: :f/ �,0 �G'� �r i/QOJ'y , �•/%y 6 �t/e
Zip Code: Fax:
City: -4 State: IAY
Phone No. .!r/7 - "�7 110
E-Mail:
Zip Code: 'YY'7j7 Fax:
Phone No ew - 901-s` lq
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License 190,F7l
from the Owner listed above)
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.
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:
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."
j
SCftaru—re of Owner/ Lessee/Contractor as Agent for Owner
s46<re of contractor/License Holder
STATE OF FLORIDA
yllc_�
STATE OF FLORIDA
COUNTY OF
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing instr ent was acknowledge before me
this A day of 201':� by
this \1 day of 20 j by
IU
Name of pbrson making statement.
Name of erson making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signat e. �t WP
(Sigha6rdlof Notary Public- Sta`t f Florida)
t pvo� •.,, LASHAH IN M-BANNING
Commission No. ':
..: • :* MY COMMISSION # GG 275060
Commis '�`= EXPIRES: Decembe60, 2 al
C0M #GG275060
o= EXPIRES: December'20,2022
rFOFF�. Bonded ru taryPublic Unrvm deters
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FRONT
PLANS .
VEGETATION
SEA TURTLE
MANGROVE
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19