HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 0- 3c9--1 °1 Permit Number:
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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:
PROPOS DIM' RO MENT LOCA ION: �
Address: ��0 J �Ko lr4,l-ec. � d
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
D N I I H E;N DENS*RIPTION O WOR+K•
LZP50&9114- Ay. S{,A �6t to ! Do /Ii n t'o
CONSTRUCTION INFORMA 100
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: Sq. Ft. of First Floor:
Cost of Construction:$ / &NJ 0_cd Utilities: _Sewer _Septic Building Height:
NOW70,11RIO&SUSEE: CONTRACTOR:
Name %oM t�Sfiee►ti. Name: Dt-" to S+"is
Address: f Vr 4J ' �min d��l�� l Company: 5+W 61 ec,4,r, e. s 16c
City: i f". 12=e'oe_ State: % _ Address: : '-49i - A/ Cc ke,, (24
Zip Code: 3 `9` T-/ Fax: City:. %t'. .iJ ferV, Stater
Phone No. Zip Code: 3194V_ Fax:
E-Mail: Phone No y7a 201 -739 t7
Fill in fee simple Title Holder on next page(if different E-Mail Jlitj S+cJldbS 33 G h;I • low.
from the Owner listed above) State or County License 300 7
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.
i
S�UFP ELEI NTAL No ONSTRUCTIONI LIEN 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
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.."
Signat a of Owner/Lessee/Contractor as Agent for Owner Signat e o ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo oing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of Ca'_$ 20_ by this�day of ('� 20� by
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
(Sfenat6reof Notary PubR6 State of.Florida (Signatur'Q• 1iYfi nj PP
�. OVA iIN
rAYCOM GP,F1W}_FA fIVG)
Commission No. : ~.s_u,YF�y�. ;� yAINGRAM RAHMIN mmissirr'^_ :a, MISSION##GGI f
t; ; ( "°� ;° ' Bonded 7 ecen;ber20 2022
4'i r: ? _*_ tAy COtJMISSION#GG 27506 ".ter~- hru Notary pU61r
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.. '•.r>FFIo:`� B_an�edThn `T
REVIEWS FRONTI i-� i�st# r "JLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19