HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �aN \4-\\ Permit Number:
,TT
RECEIVED
5
CCT J`S ?019
Building Permit Application s uUc1e County, Permitting
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: �`CC�-'
t
Property Tax ID#:c4rJf: -- b e Lot No.
Site Plan Name: Block No.
Project Name: :�� 1
.DETAILED DESCRIPTION OF WORK:
I t y—x. 11 ' ig \;.
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 _i/Roof -2_-Pitch
Total Sq. Ft of Construction: �) Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer. _Septic Building Height: _2_'zrz>
OWNER/LESSEE: CONTRACTOR:
Name �� Name: -
Address:-I�) 5� �'1 ��- -7 Company:
City: State. Address:
Zip Code�� Fax: City: Stater^
Phone No. Zip Code .. =i'b . Fax:
E-Mail: Phone No, --1"7'2_- 7) --7-
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed 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 LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _ 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
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 l 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 accessary 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."
Signature of Owner/Lessee/Contr ctor as Ag t for Owner Signature of Contractor/License Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6a-. A- COUNTY OF Sit_ La��
The forgoing instrument was acknowledged before me' The for oing instrument was acknowledged before me
this%'6 day of 4 C�* 26A by this 1_.day of 6th by
C\cx 1 W4, t
Name of person making statement. Name of pers n making stlitement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L Produced L L
(Signature of Notaig Public-State of Florida (
Signature of Ntt � ic- tat�j�,j� �tvsn+�ts
' � '- MY CdMM1SSION#GG 022V?3
Commission No. MARL@GlV6N Commission No. avXPIRES:Dece ��2�'�
ro. You MY COMMISSION#GG 022023 ` "re o"a' Bonded Thru Notary abil der;
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REVIEWS FRO T%Fq„[;420Rf ""N I'' !{cUnclerwrite=r, PLANS VEGETATION SEA TURTLE MANGROVE
COU REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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