HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 67-)-4 Permit Number:
•
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
PERMITTYPE: e
PROPOSED IMPROVEMENT LOCATION:
Address: 8-3
Property Tax ID #: ly,:? 7 " 7 6 f — U C`I4 7 6 oo -3 Lot No. � 7--
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
o ft7 S is e a-41 Yeas
1 r.m S-P L(11 'I u S r VV C4 c -H S
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: $�G� 04- Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Address:,-�gG 1 11 Y T S 'f
City: 14l a-m I Stater
Zip Code: 33 i Li d Fax: 0-�
PhoneNo.77� 7%7
E-Mail: l7 14
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: L5'f4-Y7 d wt C Lt C* v_�CA_,4,_
Company:
Address: 6 �Z 15 E-- fa 1!4 V7 eSI Ctrl
City: ps �- State: k-
Zip Code: 3,11 fjr 3 Fax:
Phone No ?19 ^3 ` a -7 ?-q -1
E-MailL� ILcxpwtGU'1fC✓�� �12C G�irivill•Ccxn
State or County License a q 3,7 ,3,-
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:
Not Applicable I MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
1-1 Not Applicable
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 PAYHIIG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCE 4ENT MUST BE RECORDED AND
POSTED ON THE JOB SrrE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FN"NCWC, CONSULT
WLTH YOUR LEADER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Less / ntractor as Agent for Owner Signature of
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 7 L- Lc ci COUNTY OF �-, -r L k c
The forgoing instrut was acknowledged before me
this � day of n ` me 20 1 �I by
f OJA AC) lam^ Wkr P.'
Name of person making statement.
Personally Known _
Type of Identification
Produced to -
(1'.
CINDY LALCHtK t�)
Notary Public - State of FlonCa
--Commission # GG 3563i7
My Comm, Expires Jul 17. 2023
zC through NAtiond: Nstdrr Assr,
(Signature of Ndtary Public- State of Florida )
Commission No. (Seal)
The forgoing instrut was acknowledged before me
this -day of me II c.,,20j by
�an Ch�m�t
Name of person makin statement.
Personally Known OR Produced Identification
Type of Identification
Produced 10 fe
""� CINDY LALCHERmB
K : • Notary Public - State of Florida
Commission GG 356317
My Comm. Expires Ju! 17. 2073
01 --IA. f.�9Cflg.1hra:gh National N.., .—
(Signature of Notary Public- State ofFlon
Commission No. (Seal)
REVIEWS I COUO TER ROEVI NING W I SUPERVISREVIEWOR REV EW I VEGETATIE EWON I SIATURTEV EWLE M EVIEWVE
DATE
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