HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J ._
•
Building Permit Application
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: Me, GA an i'� �.c�-m t f
PROPOSED IMPROVEMENT LOCATION: //� l
Address: -3L}50 7w- � za �-5 �-�!� otl i 7
Property Tax ID #: 'z 7 L� 00/ � 000 — � / Lot No. r
Site Plan Name: Block No.
Project Name: -3 # 5 D w n Li, CS`- h /
I DETAILED DESCRIPTION OF WORK: I
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:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JT AlloF
Name: l(t
DS
119
Address: 3 �✓./1 k ;
Company: �i
+ i
City: 'F0(-� State: FL
Zip Code: 3 _ Fax:
Phone No. I i �'
Address: oV.J
City: a
Zip Code: 33 \6
Phone No Pf�_L1 ) L4
94
State:lr
Fax/:r
E 006L
E-Mail: O 00 0l
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail i
i71 i +
State or County License
t�
If value of construction is 52500 or more, a RECORDED Notice of Commencement is requirejF • ;.%c, rIL«',DAwtK
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. * ,r CornrrYssiCMW1.
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UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
FD
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:
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 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."
Signature of Cont or/L nse Holder
i nature of Le e/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA 1
COUNTY OF i �( CI
COUNTY OF }{ .
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2L day of LnL -� _ 20_ by
this a day of C , 20_Ll by
`^
St
rI
Name of person making stat ment.
Name of person making statent.
Personally.Kn9�eh 0%WR�uced Id�R i �t tL_
Ut��
Personal Known OR Produced Identification
Type of Identification a°.'"•��.""-V
Produced * * commissi #GC118024
Type of Identi ica ion
Produced o `:., EILEENCDAUER
October 18, 2021
Ttru Nodry s.+'s
`
* * Commis"g)G
o� Expires October 14,
OF ThU aidpR M"
r
(Signature of otary Public- State of Florida )
Signature of Notary Public- State of Florida)
Commission No. (Seal)
Commission No. (Seal)
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