HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED00-7
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Date: I �' L�1 Permit Number: / G� ( .y ` 7
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Building Permit Applic tion
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Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce R 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R ! SCI �®�ntyr FL
PERMIT TYPE:
Address: 43,E 2 F� �� r t-Q rC PC-. .� 1-f96 2
Property Tax ID.#: _5�03 Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit-check all that apply: /Windows/Doors
_Mechanical GasTank Gas Piping Shutters
_Electric _Plumbing _Sprinklers _Generator -R'oof Pitch
Total-Sq: Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ C) Utilities: —Sewer —Septic Building Height:
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ZGNTR'ATUS
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Name VirlSDe/1 � � �4_ll✓� �7�'lssl✓r�'(�v-
-t-- Name: � C'PC
Address: Q S I Company t°
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City: s T F'! P .It2 State:f"�% Address: l
Zip Code:.* Fax: City ` p t°� C-f'` State:l�L
Phone No.,(„7Z , A7Zip Code: '3d-AW2- Fax:
E-Mail: Phone No 722- 40 I)(te,
Fill in fee simple Title Holder on next page(if different E-Mail eA c
from the Owner listed ,above) State or County License C yC
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.
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SU1�6'LEMIENT�AL CQNSTRiUCT1�N ���N 9�W IN '�6iM�R1'ION,
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 thepermit 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OFV4 COUNTY OF S�� &4��
The forgoing instrument w s acknowledged before me The fprgoing instrument wak acknowledge before me
this_,S—day of (1 20�,by this Q) day of N Iry - 20�.by
Name of person making statement. Name of person making statement.
Personally n wn OR Produced Identification Personally Known OR Produced Identification.
Type of Identif] ion Type of Iden"ica
it
Produced Produced `C
(Signature of N g y
��R$Y (Signature of Notar P blic-State of Florid
is P�;P;b, AUDREY GG 300817 Y
Commissiori'lM MY COMMISSION pUDREYB.HU4�1,H
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEG 4TI01 E7 TCJRTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ` AEVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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