HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE JFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` Q�}(�
Date: �I,1. Permit Number: l V°
NEWT,
40
P. Building Permit Application R�
Planning and Development Services 4110
Building and Code Regulation Division Apr 5?0 9
2300 Virginia Avenue,Fort Pierce FL 34982 irei V
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentialne
PERMITTYPE: A — I�
PR POSED I 'PROUEMENT LOCAT ON.
Address: f�`� �Gl�j�io2•� ��
Property Tax ID#: 3 ' 1�� 7 � C2�rc�, 0(2� � Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED Dic IPTION OE WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
&Iechanical _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:$ 'r�?j�� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:W tcag-'MamR:
Name S �9Address: 17y l /���" �ame:
ompany: �fCAM
City: �S Stater— Address: ,�7Y
Zip Code:..3`JSS'a Fax: City: PSS 'State:
Phone'No. 9Qlnc,' Zip Code:, Sh Fax: -
E-Mail: Phone No —
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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 L EN LAW INFORMATfON:
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 LENDE=R-" ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ure of Owner/Lessee/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF A Q—,( ,kc COUNTY OF Sri- L(l
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this C-day of C, I k 0 20 1�y this day of 204 by
n
Name frperrsso—m eking statnt. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification( ^
Produced �,�e Produced ® )�,
(Signature of Notary Public ate of Florida) (Signature of Notary Publi -State of Florida)
Commission No. Commission No. ELL AUGHN
LLEN GHN
State of Florida-Notary Public =o�°" �State of Florida-Notary Public
:• ._ =. .=
0F Vo"A Y Commission ExpiresOFFoP° My Commi sion Expires
REVIEWS _ d _2z. P.ERV OR PLANS VEGETA N/fill"SEA TUEber?
REVIEW REVIE
DATE
RECEIVED
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COMPLETED
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