HomeMy WebLinkAboutBuilding Permit ApplicationIm
All APPLICAB INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Q
Date: 9 1 Permit Number: `o rl - 0 3,io
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT'TYPE: O i _ -A-.
Building Permit Application
Commercial
Residential A
PROPOSED IMPROVEMENT LOCATION
Address:
Property Tax ID #: 1!!Y 31— 716.2- Q0Q— O Lot No.�
j Site Plan Name: Block No. 8
lProject Name:
-CONSTRUCTION 1NFORMATIO_'N: .
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: Sq. Ft. of First Floor: _
Cost of Construction: $ /800. ® d Utilities: _ Sewer _ Septic
_ Windows/Doors
_ Roof Pitch
Building Height:
OWNERAESSEE;
CONTRACTOR:
Name
Name: G
Address
Company:JA
City State:ft,14
Address: d'
Zip Code•,3Jf9XI& Fax:
City.
Stater
Phone No.
Zip Code: 3y9'q'5
Fax: ii is • dl& !- Q%766
E-Mail:
Phone No772 --4(6
Fill in fee simple Title Holder on next page ( if different
E-Mail/"ike-& OPA - Qb_e'S
l dal. e047
State or County License Ee-
/3 00-585 9
from the Owner listed above)
SI
5
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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _,g Not Applicable
Name:
Address:
Citv:
Zip: Phone:.
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 T EFORE THE FIRST INSPECTION. IF YOU INTEND TO OPMIN FINANCING, CONSULT
WITH VnI ID I FIUnFD hD AN I&rrnRNFY BEFORE RECORDING YOUR NOTICE OF CO EN EMENT."
SigdAure of Owner/ L ee/Contractor as Agent for Owner
Signat re of Contractor/Lice se Holder
STATE OFfLORIDA
STATE OF FLORIDA
COUNTY.OF �01� 1-,oCA L
COUNTY OF C ,c/cil L' ,
The forgoing instrume t was acknowledged before me
The forgoing instrum t was acknowledged before me
this JLO!�da``'�y-� of 20� by
this —day of v 20� by
i f, - J 1 64
o
AAA r A P �✓ r a�-
Name of person making statement:
Name of person making statement.
Personally Known _V-1" OR Produced Identification
Personally Known I/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Prod
(Signature of Notary Public- State of Florida j
(Signature of Notary Public-MaSttgte of bgoikaMond pnm
NOTARY PUBLIC
David Rayrtwnd Prue
Commission No. ! STA 6 FLORIDA
Commission No. NOTA030JOLIC
Comm# GG2870529T(JftSTATE
OF FLORIDA
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
EA TURTLE "
0MROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19