HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �11�D` �� Permit Number:
is -
' CEIVED
Building Permit Applicatio
Planning and Development Services SEP U 5 2° j�
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie Cou , Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residen la
PERMITTYPE:
PROPOSED tMI�ROVEMEN LOCATION:
Address: 0f rz X2..
Property Tax ID#: �y� ) ' 1 - U��01-O 04 - Lot No.
Site Plan Name: Block No.
Project Name:
DET ILED DE�SCFt+IPTiON OF WORK: .,.p
1W
C<?
CONSTRUCTIO IN' ORMATION:
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:$ Utilities: —Sewer —Septic Building Height:
OWNER/L0AN@E, CONTRACTOR:
Name . NaMe:- �:__. .: :;,.; : _,_ J
Address t2� cti.r� ��lr Company (
City:- I -r 'r..^: i!<�rC :. .:. State:
Zip Code:: y- 2 Fax:.'i City: t` PState:
Phone No. = -- Zip Code: Fax: y��- W-')
E-Mail: Phone No 'z S`
Fill in fee simple Title Holder on next page( if different E-Mail J CC.- f-}_L'�} ;
from.the Owner listed above) State or County License C C
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 TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDAVIT: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 a,pplicable,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,l 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 LENDEROR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign at r O ne ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k. k-Q'Z NK COUNTY OF 4— • ti Llc�e
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this.s day of ��?,o , 20 N by. this day of S- 20 1A by
W-% y r l+rl
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known.. OR Produced Identification
Type of Identification Type of Identification
Produced L fl%.' . Produced TL L
(Signature of Notary Pu • • t�„of F46YMMISSION#00022023 (Signature of Notary P lic- p1A1 ro#GGOgyo23
EXPIRES:DmmWr 16,2020
Bonded Publlo Und�rwAtuits `v?�'•=:;F OM►A1SS �B,2020
Commission-No. O ► Commission No.� - ;a �ndenxdle�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.