HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: a �.
o F
Building P rmi Application
t
Permit
Planning and Development Servi
es
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: AO EL t
Property Tax ID#: r3l D W 1 n16 0`7 06 0 n `7 Lot No. l�
Site Plan Name: A 1 UJmJ &Q.k (AA;'7 10• , L K � �� � ���
e o Block No. /
Project Name:
i
llftfiTAILED D9 ORIPTiON OF WORK:
OL o V e, XL It
.00
CONSTRUCTIONINFORMATION:
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Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors
Electric _Plum 'ng _Sprinklers _Generator _Roof Pitch
I
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Too, 0 U Utilities: —Sewer —Septic Building Height: rt"�
DWNE�R/LE�SSE : CONTRACTOR:
Name �W Name:
Address: Company. a
City: L Lw tate:.. Address:l
ZIP'Code:. 6' `� Fax;'_':'.. City: State:
P.honeN6. CNO_ 700q Zip.Code:_,.�( `YC3 Fax:_ _AI_. /'4
E-IVlail`
V6 Phone'No'
Fill in fee simple Title Holder n next page(if different E-MailP4 All
from the Owner listed above) State or County License i
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.
I
a «« . -
� . . .
PPLEMENTAL CONSTRUCTION LIEN LAW INFQRMATIQ
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: hoe Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: p Name:
Address: �i � 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 pe'rmit'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 restrictior prohibit such
structure. Please consultwith yoLr Home'Owners Ass6ci6tion and.revi'ew your deed for any restriction"s which may apply'
In consideration of the granting of this requested permit, I do hiereby agree that 1 wild,in all respects,,per-form the work
in accordance with the approved plans,the Florida Building Codes,and St. Lucie County Amendments..
The following building permit applications are exempf frofn 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:'SR.AN ATY
fiRNEY BEFORE.RECORDINGYOUR NOTICE OF;COMMENCEMENT." .
000,
Signature of ner see/ ractor as Agent-for Owner` Signature of•.Con'tr r/Lice older'STATE OF -
COUNTY OFORIDA��L Lu — COUNTY OFSTATE OF ORIDA
The forgoing instrument was acknowledge fore me The forgoing instrum nt was acknowledge, before me
this day of 20 y this day ofl, 20by
} A A n—ar
Nam of person making staterren . Name of person making sta ement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced� Produced
(Signature of Nota (Signature of Notary Pub e of Florida)
`,AW PVA ELLEn�
UCHN
Commission No. ,: `�:Steto of F1 Us Commission No. .moi°`ARYP`s�'o �(Ls @ ' '
NotHr`y public _,
c dmfni"I" 1! �3d-�700�0 ?;F SCOQ®i Florida N JGHN
%.;nor v,o��` y .ofiiMit;FiSft mmis�lA y Pub,'
'202inn. t® 'lsbiory 078
REVIEWS FRONT ZON;fPf ; - R PLANS VEGETATION_
COUNTER..'. REVIEW. REVIEW REVIEW REVIEW REVIEW
`DATE „
RECEIVED
DATE
COMPLETED
Kev. 2/7/19