HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'✓��` Permit Number:
RECEIVED
• _ SEP 13 :'_,o?q
-- - -- ___ Building Permit Appli tion County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ,C
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT TYPE: ^ ` Fol-
PROPOSED
USPROPOSED IMPROVEMENT LOCATION:;',
Address:_�.�� \C, V AN A
Property Tax ID#: L% 700 1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED bESCRI PTION OF WORK:
Do �A e)
FcONSTROCTION-INFORMATION: W`
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
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Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _.:
Cost of Construction:$ HL-A,50 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: : CONTRACTOR: ,
Name� C1 C (a ame: CA-M-tJ ��
�l L l S�{
Address: 1��,°� O�U C 1 f Company: ( �10��Q� _
City: �U Na Orr State: 0- Address:
�9mo Fax: City: � P%QrCk State:
Zip Code: —
Phone No. Zip Code: `31Aq 9-211 Fax: 'x'17—14.0%—,SI43
E-Mail: 'Phone No (—r)-2k — �-ALDV—,.c J
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Fill in fee simple Title Holder on next page(if different E-Mail 1,� C�.kv�� ro-,;l O— (zm t- cc/m
from the Owner listed above) State or County License
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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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.Lucie County makes no representation that is granting a permit will authorize thepermit 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 PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMM CEMENT MUST BE RECORDED .AND
POgON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU 111 D TO OBTAIN FINANCING, CONSULT
W H OUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTI IF COMMENCEMENT."
Signat of caner/Lessee ontractor as Agent for Owner Signature ntractor/License Holder t��_
ST E OF FLORA STAT OF FLORIDA
C LINTY OF S . L��'�@ CO TY OF 5 �C• N--0 -
The f rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 1sQ y 20% by this�3 day of 5� �'� 20 by
J d.sc ,^ 'S'r Q pose J
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 f L D Produced
(Signature of Notary Pu c-State of Florida) tureublic- 2023
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REVIEWS FRONT °`'� Dade OR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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