HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Number: 910 0001
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _ C
PERMITTYPE:
PR'OPQSED IMPROVEMENT LOCATION•;
Address: GLimoC% L i� r-�
Property Tax ID#:' 3g69_ I3`66fj-ZOG-Z
Site Plan Name:
Project Name:
,.DETAILED DESCRIPTION OF. WORK
I . _
0� o )d N
CONSTRUCTION INFORMATION;
) U)i n Al 6G)s I(
Lot No. )
Block No.
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: $ 1),000 Utilities: —Sewer —Septic . Building Height:
OWNER/L'ESSEE,_t i
:CONTRACT,OR
Name Av L-atu' ec� L:. d0i
Name: -l- oAl� Own-,--<
Address: � 9 a 3 R w er JqA_.141 0CI_ � N
Company:
Address: M 0 3 , J1e,r um'L�O C K � N
City: Pce'rG-c State: L
;Zip Code: : 3`fffll Fax:
City: Ffi i iYctC"e State: r-�
'Phone No. -7-7 7o - 6 q-L 3
Zip Code: Fax:
E-Mail:- L[vidc,s� io o.rgo IrNer5Nu" kr, cam
Phone No �(7 Z- '37d-09Z'3
Fill in fee simple Title Holder on next page ( if different
E-Mail LAn du- @ (n than n V"er SJL L#cr. C b�
from the Owner fisted 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.
SUPPLEMENTAL CONSTRUCTION LIfN1AW 1
DESIGNER/ENGINEER: f Not Applicable
Name:_
Address:
City:
Zip:
Phon
State:
FEE SIMPLE TITLE HOLDER: -4 Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: iD S A Ox
Address: Po B o� SyOD
City: J._,e o ,5+0n State: A
Zip: 04243-514co Phone: 800•;2-0• Zu
BONDING COMPANY: �( Not Applicable
Name:
Address:
City:
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.
Stt 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.
Inconsideration 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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATMRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si u e of O er Lessee C ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFi,.,.�.� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiO day of _Q Cje 20�5_ by this day of 20_ by
Name of person making statemerR. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi ation Type of Identification
Produced�� U * Produced
ignature of NotarjTubli& State of Florida) (Signature of Notary Public- State of Florida )
Commission No. `l %%o:,7 LASHF4fttl�GRAM-RAHMING Commission No. (Seal)
� _-;_
.#; MY COMMISSION # GG 275060
cern2022
Bonded Thru No ry Publio Undenvdters
REVIEWS FROi PLANS VEGETATION SEA TURTLE MANGROVE
! COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.