HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED lQc c(�^� 'Q
Date: Permit Number: ` ` ' oqn
Building Permit Application
I 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
PERMITTYPE: -
PROPOS D 1`MPR01/EMENM LOCATI(�7N.
Address: aS3 1n
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: l9 eort" e19 /LCf2
QETAILED RUS :RIPTION OF WORK:
f -
CQNSTRUCTION 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
i
Total Sq. Ft of Construction: O Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
CIWNER/LESSEE: CONS ITI C3R:
Name Dye & tZ Name: /o6w
Address: ;L M "-�q- Company:
City: d— State:,'f I Address:
�7
Zip Code: Fax: y� City.: ice'' `/� t' Stater
Phone No. r �1Z/ / Zip Code: 1. .t� r/ �/" Fax: y
E-Mail: Phone No-
Fill in fee simple Title Holder on next page(if different E-Mail A
from the Owner listed above) State or County Licen C.
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 LA INFOR ATI�N:
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 !1 O1 �1ENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED 0 THE JOB ITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y (I LEII OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signatur7FFLLORIDA
wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE STATE OF FLORIDA
COU�� OF COUNTY OF
The f•rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 k� by this day of 20_ by
Name of person making4tatement. Name of person making statement.
Personally Know OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( ' nat re of Notary Public-StatI6 of Florida) (Signature of Notary Public-State of Florida')
Commission No. Commission No. (Seal)
iIISHAHNA G -WMING
•c ;,, My COMMISSION#GG 275M
ecem a 0,2022it
REVIEWS s ° XW
aryPal W R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
RECEIVED
DATE
COMPLETED
ev. 2/7/19