HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /9 Permit Number:
�COUNTY
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: o? o
JP_ Lkgt2t_-
Property Tax ID#: Lot No
Site Plan Name: 1 LL Block No. Q8
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Project Name: //l��Q4 ) A,(j dMd.&T1_ innq 1 rY?/ A1.0 /
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
$Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ $00• DO Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameName:
Add ress: Company:
City: Statei-L Address: CQ__6
Zip Code:J!'SQ Fax: Cit State
PhoneNoj_?9., 4o40L f Zip Code: -;:�q9.S & Fax: -R779
E-Mail: PhoneNo-�7o?, • �'4,/-07-77
Fill in fee simple Title Holder on next page ( if different E-MaiI/hZk—t&Qr0,a� -R LwSt2IL.C oM
from the Owner listed above) State or County License
SI-4.G9 75
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: _,>C Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _yNot Applicable BONDING COMPANY: XNot 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 LENDERGR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMS CEMENT."
De I
Sign re of Owner/L ssee/Contractor as Agent for Owner Signarurcrdf Contra ctor/Lic se Holder
STATE OF FLORIDA
,� I STATE OF FLORIDA
COUNTY OF }# 1 COUNTY OF �A,C�4 A--
The forg ng instrur n was acknowledge before me The for ��ng instrum t as acknowledged before me
this��ay of v 20 by thistlay of 20_4 by
Name of person making statement. Name of person making statement.
Personally Known JX OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public Sta e of Florida) (Signature of Notary Public-State of Florida)
y Ip David Raymoid Prue
o ��� 106mmission No. 1 David R Rue
Commission No. NOTARY PL) S°� NOTARY PU 1
STATE OF F ORIDA
STATE OF FL DA
Expires 1/26/2023 r ?Comm#G 228
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RT A '�TVIItJ� VR26 2 3
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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