HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE
COMPLETED FOR APPLICATION TO BE ACCEPTED (�-Q ,r-1
Date: � �/1 Permit Number: (A 1 �yP 75
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- -�— Building Permit Application sNN, 9'0
Planning and Development Services 40,
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Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSED'IMPROVEMENT LOCATION:
Address: 9 .0 dylpr /f?r 3Y9 5-1
Property Tax ID#: Z (4p 13 " O o;7.3 b - DDD — 0 Lot No.
Site Plan Name: p Block No. �
Project Name: �/�•) Ql �l'
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DETAILED DESCRIPTION OF WORK:,
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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:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR: ,`
- '
Name Ve fl
Name:
Address. Ave— Company:
City: CF State: Address: 70W) ri
Zip Code: Fax: City: e KI State:
Phone No. Zip Code: Fax:
E-Mail: Phone No(255 77
Fill in fee simple Title Holder on next page(if different E-Mail C& —CS cotr
from the Owner listed above) State or County License CSC 132- Y] 2
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 CONSTROCTION 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 COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. 1 YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH NUR UR LENDER OR AN ATTORNEY BEFORE-RECORDING O NOTICE OF COMMENCEMENT."
Signature Own se /Con ractor s A r er Sig ture ontract /License older
STATEOF FLO IDA�a, STATE OF COUNTY F OR
COUNTY OF
The forgoing instru was cknowledged before me The forgoing ins nt was knowledged before me
this day of C1, 20 by, this day of ' 20 l-T_by
9
crt�I i�IRS_ VA
Name o person ma ing statement. Name of person m king statement. 19 --5 OPersonally Known OF Produced Identi Ricin o Personally Known OR Produced Ident' cgtaroType of IdentificatiRn _ z Type of Id n catio , , W Pr ed1cR I Produced fit °`•. CISH"` o d 'ia [.cZM . LLU O X L - � =W aWc �W .— 4 O w Signatu a of tary Public-State of Florida) m ure of Notary Public-State of Florida� �Commission (Seal) m Commission No. (Se ; 0-01
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O� �i0a#ry*SPl`v:
REVIEWS FRONT ZONING PLANS VEGETATION SEATURTLE MaPf v
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19