HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
����[� ( Permit Number:
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Building Permit'APPlication
Planning and Development Services
Building and Code Regulation Division c'oo
Aa
2300 Virginia Avenue,Fort Pierce FL 34982 cO��
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE: "
PROPOSED IMPROVEMENT LOCATION: ,-''
Address: c ( {Ce_�ccutd
PropertyTax lD#: I�O –��� `O� '� C3Cbl Lot No.
Site Plan Name: Block No.
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Project Name: V'1nct�j
DETAILED DESCRIPTION OF WORK:
iro&� *aU o in G�ht�L 15 $ SyS-cin atf--Adt"W4 13 Ise
Ad WLrr� W cJ A-ee
CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit–check all that apply:
_Mechanical `Gas Tank ,Gas Piping Shutters Windows/Doors j
—Electric _Plumbing _Sprinklers _Generator Roof r Pitch
Total Sq. Ft of Construction: g Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name b (akic' HoyhSb!, Name: Se.[5;0 2-C,I; fi-')GM
Address: '0( (,.AIC fnh d Q/U,4- Company: .0ctNda Cc �c YJ
City: }' (�t-cyice- State:�- Address: 456a OS 44W`� 1
Zip Code: g 5-1 Fax: City: vu Z) Qer,ci, State: w--
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Phone No. Zip Code: Fax:
E-Mail: Phone Na
Fill in fee simple Title Holder on next page(if different E-Mail, `C �� Ynd�tCEWt i t�acf of S. �Yti,
from the Owner listed above) State or County License_QQ(Qq 0-'
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:
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.
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 j
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."
4
ature of Owner essee/Contractor as Agent for Owner Signature of Co r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF InC�:Cth COUNTY OF '1 (2dAef-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this`),SR day of 0(_Vtig f 20 (9 by this '25�clay of r •{ t.Y 20 t by
i
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 Produced
Jig K.Samberg
(Si a of Notary Public-State of Florida) (Sia of Notary Public-StSchea"
(NOTARY PUBLIC
e�.^ TATE OF FLORIDA
Commission No..95- ym .' S I •Bamberg Commission No.�s`Kg0 =W` 09
ARYPUBLIC
M �tpirEes 8130!2022
STA1TE OF FLOR
O GG254409
REVIEWS FRONT MG Exp r(WEA6PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19