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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:1�— l Permit Number: RECEIVED ' WM Building Permit Application permlttin9tm •oeparent Planning and Development Services St. t Lucie Coun Building and Code Regulation Division N 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT TYPE: PROPOSED IMPROVEM T LO ATION Address: o (5N c I/9 U-f- Property Tax lD#: 3-3 z-Z-- a6 Q ©6/3-6c)C9 -- Lot No. ID Site Plan Name: Block No. Project Name: DET ILED DOff' ouON OF WORK: CONSTRUCTION INFO MATION: Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electriclumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: w Cost of Construction:$11 7 S Utilities: —Sewer —Septic Building Height: OWNER/LEI-SSEE: CONTRACTOR: Name Fle 00Y mwrl_n l� Name: Address: /6 ��, SIC-(0 Company: 4gvw\1)J)S IfWP4, City: (JS L state: L- Address: P'L S` C9 2a'wi Zip Code:N"?fir(, Fax: City: r2 I State: Phone No. �Z USG 2 g'Os, Zip Co e: 3 ��� Fax: E-Mail: Phone No 2 1-70 /1 �y Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License S�S� 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. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone:. FEE SIMPLE TITLEHOLDER: 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,swimm.ng pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use "WARNING TO OWNE ' YOU FAILURE TO RECORD A NOTICE OF COMMENC ENT MAY RESULT IN YOUR PAYING TWICE FOR 1 P VE T TO YOUR PROPERTY. A NOTICE OF CO ENC ENT UST BE RECORDED AND POSTED O JO BEFORE THE FIRST INSPECTION. IF YOU TE TO INANCING, CONSULT WITH YOU L DE AN ATTORNEY BEFORE RECORDING YOUR TI IF CEMENT:' Signatur..` of Owner/Lessee/Contractor as Agent for Owner Signat r of Contract r/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTYOF The forgoing instrument was acknowledge ore me The forgoing instrument was acknowledged, efore me this_ day of 11,Q,W /,20_ by this��day of �.lQ�� 20 by aMA Name of person making statement. Name of person making s atement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification II Type of Identification Produced. l� Produced �L�. A )rp (Signature otary Publ -State of Florida) (Signature of Notary Publi ate of Florida ) Commi io9 JJAOZ 'ZZ aa4oiop \�.o Co i� i ►), o. al) r-PGHN 6LOOLZ JJ# uolsslwwo3 : 2` a*°` =*:State of Florida-Notary Public i ti uo o a e N Jf1dA N311oP My Commission�ExRi� L MANGROVE REVI UPERVISOR P GETA(Yk—k ier 22� COUNTER REVIEW REVIEW RE I REVIEW DATE RECEIVED DATE COMPLETED ev. I