HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED pp P
Date: t Permit Number: Lq t) " 7
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Building Permit Application ��go � `"���
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:
Address: 657 Y e-n e-C S f,1 e- Q�e-rCr-1 F1_ 3 L- 7 CI A,
Property Tax ID#: ( L'( 314-_7<) : (O a-3 ^ O lcl O - CJ Lot No.
Site Plan Name: Block No.
Project Name:
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MR NINE
NO
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank i Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing Y Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 2-100.5-ejC1 Sq. Ft.of First Floor:
Cost of Construction:$ l d 1 p,0 Utilities: _Sewer _Septic Building Height:
Name 5VNk ACL La Name: k " t ear
Address:( -b,5� .Se.!af A`r Z- Company:)
state:E_-L Address:t`� 3 5i.�- Gly- cle S
Zip Code:3 t-( c1 t{ !o Fax: city: Po k- 1...�t6( _ State:. j
Phone No. Zip Code: -5 Fax:
E-Mail: Phone No-1 X(CC) 5�_'5 '
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Fill in fee simple Title Holder on next page(if different E-Mail S 6o
from the Owner listed above) 1 State or County License(-, C_C-k331 1`10
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.
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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:
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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 1 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
WITOUR LENDER OR ANATTORNEY BEFORE RECORDING NOTIC. OF COMME MENT."
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Signature of Owner/Lessee/Contra s Agent for Owner Signature of Contractor/License H de
STATE OF FLORIDA ii '' ,, STATE OF FLORID j
COUNTY OF l COUNTY OF t (:1A�n �
The for oing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this day of 20by this day of 20 'by
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Name of person making statement. Name of person making statement.
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced Ems.
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(Signature of Notary Pu Loff Mforida) (Signature of Noblic-State of Florida)
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Commission No. �z° e;:Stat� N VAUGFiNImm'ssion No i° I I
�; °t lorida-Notary Publ - N
Qo`, Commission #GG �c C to of F ori VA
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Ission Expires '��mm`\ Y Co °n#G3 ry public
REVIEWS FRO N Octo R LAMS VEG CIPAt Itron fk RRG VEI
COUNTER REVIEW R EVIEW REVIEW 2, 2C22 !I
DATE
RECEIVED
DATE
COMPLETED
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