HomeMy WebLinkAboutBuilding Permit Application a
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J /�� n �y
Date: �L Permit Number: V 11.�� y
_ Building Permit Application c�P00 O-e 9
Planning and Development Services PAF
Building.and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: \AY
PROPOSED IMPROVEME iffillLWAVAILN.
Address: 0
FaA P1,tom
Property Tax ID#: �� _ , - �I ��� Lot No.�
Site Plan Name: p,` Block No.
Project Name: 1�
DETAULED DESCRIPTION Qf VNORjK:
+�QN�TR-UCTIC?N 1NFORMATION:
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: l DOD SG Sq. Ft. of First Floor:
Cost of Construction:$ A(Do. 00 Utilities: —Sewer —Septic Building Height:
O.WNiER/LESSEE: CONTRACTOR:
Name L Name:
Address: 31 S JMpIA&r Company:
City: State: rt'\. Address_:-*.
Zip Code:3qn 53 Fax: ",City:. State:
Phone No.-1-1a= S-10_ 3� Zip Code: ,; Fax:
E-Mail: V cze r c Phone
Fill in fee simple Title Hoger on ne 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.
SUPPLEMEN At CONST UCTION tIEN 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 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
STED ON THE JOB SITE BEFORE THE FST INSPECTION. IF YOU INTEND TO OBTAIN.FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNIrY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
`?-� /
tgnature of h7�z�6 �67�
Owner/ essee/Co actor a Agent for Owner 7 ignatu f Contractor/License Holder
STATE OF FLORIDA cc STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this v ay of 20 -:;t by this day of 20_ by
QVeCLVP-m I 2S:jS t
Name of person making statement. �� Name of person making statement.
Personally Known OR Produced Identificatiot Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
L/V
(Signature of Notary blic—State of Florida ) (Signature of Notary Public-State of Florida)
Commission No. IN, ELLEN VA ( No. (Seal)
�_State of Florlds-N ta*e Commission # GG 270079
My Commission xpiros
REVIEWS FRONT Z 2 2 VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19