HomeMy WebLinkAboutBuilding Permit ApplicationYMITIC A
�APLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: 1617g Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Building Permit Application
Commercial Residential Vz
Address: 94,q i C T ,
Property Tax ID #: 153 q- ,5-o3- Q1l(J-nn0-3 Lot No. �a-
Site Plan Name: /gEAL /xYn U Block No.
Project Name:
Additional work to be performed under this permit - check all that apply:
Mechanical i Gas Tank ` Gas Piping _, Shutters _ Windows/Doors
Electric ` Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
�G
Cost of Construction: $ _'
Sq. Ft. of First Floor: _
Utilities: Sewer _ Septic
Name !\ f1YLYT F1- WhOE
Address: Qqlq !- `-? /V > �
City: Pt < rE2Cr State: FL
Zip Code:Fax:
Phone'No. _
E-Mail:
Fill in fee simple Title Holder on next,page ( if different
from the Owner listed above)
Building Height:
Name: V 0 rY /Il
Company: t C
Address: J 'WA l%
City: PT 11*'P1Or CL' State: �L
Zip Code: a5y1q R Fax: L1101-4629S
Phone No ' /— 39
E-Mail
State or County License Ee Co `l 3
- --- --- -- 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'.
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.DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
I
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 the permit holder to build the subject structure
bylaws that may restrict or such
,which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit
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,
Iaccessory 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."
Signat of Owner/ Lessee/ ontractor as Agent for Owner
Signatont ar ctor/License Holder
u of C
STATE OF LORIDt3 / ' '
STATE OF FLORIDA
COUNTY OF
COUNTY OF
j
The forg ng instrume aaI nowledg before me
this day of 0 III
The or Bing instr t w acknow ledg before me
this day of 26�7 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 Identification
Produced pC"f
Produced
(Signature of lJ-0Lq IlyllyULAIL.-
A H N
(Signatu o , , - tate of Florida )
�O�pRY PV�i
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;_ ;State of Florida -Notary Public
Commission '* Commission # 63*0079
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