HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i ( � H t Ici Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential
Address: 5 c)(0 i(0-Ce- cc, K P fir.
Property Tax ID #: t 31 a -5L Cot -1" 000 ' Lot No.
Site Plan Name:
Project Name:
LDETAILED DESCRIPTION OF WORK.WIN
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric ✓ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ C_Z C.(1
Name : li�h Ze-e- D
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Address: S1 0(, PVA f_LLk VL0Z)r'.
City: it T-CR, State:
Zip Code: 34 ( Fax:
Phone No. 3 04 - S 4y - 3 S LJ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: r� rr- S
Company: C�L 1 J moo..
Address: q') i S S• 0 S %-LJ�,
City: c' ► State: r C
Zip Code: 3`{`i1r a Fax:
Phone No -1 Z_
E-Mail C'<-e�(�y �5''S �� • eJ�
State or County License _F( ` 14 Vi 31 g
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.
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY;
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 AWATTORNEY BEFORE RECORDING YOUR NOfiICE OF COMMENCEMENT."
Signature of Ow er/ Lessee Contractor as Agent for Owner
Sign re of Con actor/L! ense Holder
{
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF (`v� ;
COUNTY OF rz r- ; I - .�
The %going instrument was acknowledged before me
The folr�oing instrument was acknowledged before me
this �t day of (y�2� ►0,1 20 1) by
this `� day of Al)dre ti!ao.;' 20 by
Name of person aking statement.
Name of person making statement.
Personally Known jOR Produced Identification
z
Personally Known ✓stOR Produced Identification
Type of Identification
of Identification
Produced Notary Public State of Flory
afro -iced
Kerri Lee Hite
Commission 38740
Expires
w Expires 08/19/202323
ignature of Notary Public- State of Florida)
(Signature of Notary Public- State
Commission No. �(� 3(o�4ii� (Seal)
�►� Notary Public State of
Commission No. �l� �JL-ILI �' ,@rriLee Hite
Commission GG 36
Expires 08119/2023
OF I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19
+P�►* Notary Public State of Florida
Kerr! Lee Hite
y r� Z My Commission GG 367402