HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number19 (p -0- A��
:
ERESDBuilding Permit Application2.019
Planning and Development Services PermittIng
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED,IMPROVEMENTIOCATioN.;
Address: J� 2
Property Tax ID#: /"7- 600 Lot No.
Site Plan Name:& Block No.
Project Name:
DETAILED DESCRIPTION OF"WORK ;
OD
CONSTRUCTIOWIN'FORMATION.
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:$ /OC)o,o o Utilities: —Sewer —Septic Building Height:
1IUNER/LE$$E CONTRACTOR:
Name Name:
Address: //�� Company: �00
City: /"X'4t Stater Address: dQ41.3
Zip Code: 31/9./ Fax: City-. � State:
Phone No. Zip Code: 3y9yJr Fax: 717;—
E-Mail: Phone No G/- 2 7-73'
Fill in fee simple Title Holder on next page(if different E-Mail Miert' (Sd-t- RIe4_1h iC'". r,om
from the Owner listed above) State or County Licenseh e 19,0-_1-RSV
_P4A SMS
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.
S:UIPLEME�U4 �+L GONSTRUG�'!"ON�L��N LP,VIf INfORMATf01 � }� � �A� � � �`��
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ,. Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: -,.v Not Applicable BONDING COMPANY: VNot 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.
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 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 OBTAI INANCING, CONSULT
WITH YOUR LEN ER OR AN ATTQRNiFY BEFORE RECORDING YOUR NO ICE OF COMME E ENT."
-v_ __a
Signature of twiirrl Lessee/Contrakfor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLO )) STATE OF FLO!r JZ2af
COUNTY OF � ( ,l/G� COUNTY OF Q.,
The for ing instru nt s acknowledged before me The for ng instru a as acknowledged before me
this ay of 20 by this day of r r 20ley by
f
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
Pr ced
Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
tW-y David Raymond Prue r� David Raymond P e
Commission No. Al O�aL NOTARY P BLUlnmission No. J of NOTARY PUB
=STATE OF LORIDA ESTATE OF FL R A
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REVIEWS FRONT ZONING SUATITIR 95AIS VEGETATION SEA TURTC 11 MANft0fe_6/ 0 3
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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