HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9- A-lq
iCOUNTY
.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number:
Building Permit Application
PROPOSED IMPROVEMENT LOCATION:
Address:
Commercial Residential Woo
lt�,(Yp�,-FIDt1/�a 3K0.4'7
Property Tax ID #: ZvtD %A- bO 9 -607S-,QQQ s Lot No.
Site Plan Name: 6X-AZA Ctil%dIAAS Block No.
Project Name: II
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: low Sq. Ft. of First Floor:
Cost of Construction: $ g w/ f & Utilities: —Sewer _Septic
_ Windows/Doors
Roof -9 IA % Pitch
t
Building Height: t o
OWNER/LESSEE:
CONTRACTOR:
Name MPAM F�,CWiiS
Name: C
Address: Z707 st - S
Company7C 11 06 ,
City: nw ?kelcei State: 'FL,
Zip Code: 34a W7 Fax:
Phone No.
Addres
City: 111iAel State:_
Zip Code: 3ti4qtR Fax: 77--'r�Lt=-,
Phone No Z-+�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail �kmiw6g # OeF
/
State or Cou ty Licg�se
--� q
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
If value of HVAC is 57,500 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:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE T1Tlf FIOl.1DER: 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 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 MAT 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
Wil YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
/ I )
4 A
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Sig t&e b7 Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA I
COUNTY OF S Vt W C
STATE OF FLORIDA
COUNTY OF L�L.4e.
The f �rgoing instrument as acknow dge before me
this Try day of - - 1 7by
The fo g ing instr ent s cknowledg'We before me
this day of 2- MIA by
Name of person maki-n/g statement.
Personally Known OR Produced identification
Type of Identifi
c ion �L Produced
Name of person making statement. 1 /
Personally Known OR Produced Identification
Type of Identificati
Produced
a
(Signature of Notary Publicforid� Yv,o-E: State �,ra-ta
iarn• r. • 6-o-
Commission No. 'q _. f E*•� e; •?.2.2'
(Signature of Notary Pub Flori �; U,p. e:;:; •ja25•.
Commission No.
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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