HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE
(INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: -a& � 1 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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
ddress:
Property Tax ID 1
sit Ie Plan Name:
Pro ject Name:,_
T
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
L
Lot No.
Block No.
ditioonnal 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'
al Sq. Ft of Construction:
;t of Construction: $a�oo
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name v
Name: IPIUNMX OS
Addrss. � Y'. •�a
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Company: � cn
Address: `-{ tn/
pp
(City: �i~%sp�A 9 e State: �(�
City: %,r��" I -,, to &_ State: Ft_
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Zip Code: �`i5ISNJ Fax: NO
Phone No.
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Zip COde:""SS Fax: N
Phone No l - G
E-Mail: In/Ih
Fill in fee simple Title Holder on next page if different
E-Mail �IGcin -zs u Ap—i—
State or County License
from the Owner listed above)
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value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 I 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 1consideratiori 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,
acicessory 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
a:n
COUNTY OF 9��
COUNTY OF ,�-
en
Tihe forgoing instr t was acknowledged before me
The forgoing instru ent was acknowledged before me
his CQ6 day of 20J_a by
this day of 20� by
Name of person m6king statement.
Name of perAq making statement.
\
Personally Known OR Produced Identification
Personally Known OR Produced Identification Ni
;Type of Identification
Type of Identification
Produced
Produced
;tiny r(; ---�
(Signat Notary Public-S to of Florida)
(Signature of Nota :N a 2�tat�' lt,�@jtm#GG275060
i �a<•M F� c , WHAH, RAHMING
Commission No a '��
MYCoMMISSIO
41 vF 1 o EXPIRES. Decembe?20, 2 22
°F F`°P Bonded 7hru Nota
Commission No. �
( 0JF
�$��Jnderwriters
}. #GG275060
EXPIRES: Decembel'20, 2022
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Kev. 1/ // 19