HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
AR eE
Il i _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fah: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 3cJ —
Property Tax ID #: L�Caa — — Lot No.
Site Plan Name: �r�� Block No.
Project Name: Cl Y� 1J��C t ��t a\ 02%
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 1 Name:
Address: Company:
City:C, rp'jCa State: Address:
Zip Code. , Fax: City: PState:
Phone Norma -c:;f9 3 " (6-7 U�o Zip Code: L Fax:
E-Mail: Phone No —
FT" ; ) r- - simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County Lice n�'_r S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value (0 ".!AC is $7,500 or more, a RECORDED Notice of Commencement is required.
S _ PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
C' •.IGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
NDme: Name:
Address: _ Address:
Ci v: State: City: - State:
1 Phone - Zip: -- Phone:
F E TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
f _ Name:
/- Address:
C City:
7 Phone: Zip: Phone:
O`-ONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I , no work or installation has cr menced prior to the issuance of a permit.
St. ity makes no representation that is granting a permit will authorize the permit holder to build the subject structure
wI nflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
sti case consult with your Home Owners Association and review your deed for any restrictions which may apply.
In ition of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
v✓ith the approved plans, tic Florida Building Codes and St. Lucie County Amendments.
dinzi permit inn;irati ,rc, exempt from undergoing a full concurrency review: room additions,
spills, signs, screen rooms and accessory uses to another non-residential use
n nwNER: YntIR FA f' TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
R IMPROVF"11 NTS 'UR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
ON THE JOB SITE BLS t;, E THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
)UP LENDFR OR AN ATT ^JEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
r - - -
erContract i;ent for Owner
L��l
" IDA,"��
ure of Contra cTor/License Holder
STATE OF FLORIDA
COUNTY 0FfY—y--_z5"
in trument was acknowlk i before me The f r oing instrument was acknowledge efore me
n` , by this day of �� 20_�by
I lor„ stnName of person making statement.
_ P'< <'to tification Personally Known OR Produced Identification
,on Type of Identificatiot
Produc d
I (Signature of Notary PubIT- State of Florida
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) `�-'�) Commission No. ()� ea1)
o,,Mc State of Florida %�,
rt''�►t&Fl��lbt PuW,CState ofFlorWa
= IMCevin D Cook
%;� My Commission GG 349462
�?�� Expires 06/27/2023
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