HomeMy WebLinkAboutBuilding Permit Application i
AIfiAPPLICABLE IN 0f MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
` Date: �� I 1 Permit Number:
omAm
Building Permit Applicatibv 4r �o
Planning and Development Services
Building and Code Regulation Division Coed?
2300 Virginia Avenue, Fort Pierce FL 34952 oy�P4E
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATIQN:,
Address:
Property Tax ID#: ,���^ RN - CCn3_CM_ Lot No. -
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORKG
tr' l�rl1� c,,_V\
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: $ r-,(-M Utilities: —Sewer —Septic Building Height:
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O�UVNER/LESSEE: CONTRACTbR,:
Name .--W uv l)CPXn Name:` wH
Address: 1 "O 5- Company: k& C f1 Gin .
City: e� I� J State: Address: k,0M
Zip Code: Fax: City: i✓�
n
PSco State:
Phone No. `�`�,�-(o���b�g1 Zip Code: Fax:
E-Mail: Phone No 0`' -",)-,�oZ2
Fill in fee simple Title Holder on next page(if different E-Mail M
O!'YIE� CIAU.`0@ Com`• �r
from the Owner listed above) State or County License CC 1300 Gy�
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.
SU.PPLEMENTALCONSTRU`CTION LIEN`LAW-IN�FORMATION:
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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:
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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.
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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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signatu� f Owner/Lessee/Contractor as Agent for Owner Signat of Contractor/License Holder
STATE OF ORIDA. STATE OF FLORIDA ��
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The fo ing ins rumen was acknowled before me
this day of c r' �� 2 by this day �2 by
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 Identificatio
Produced Produced
(Signature `¢a6IG�t�@i�esf4ddbalarH Public (Signature N� ,P - da)
Commission # GG 270079 . ELLEN
i9tf OF ROQ,O` My commissioqq X,,q�feS �. �.$t VAU
commission o:'��i a`' October 22,144 Commissio ate of Florida"
#Not�r u�i;c
OF flO\ MY Co GG 270079
mmission
, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19