HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 0 1
Date: / I /]-?-/Jl Permit Number: jqjj_G�z
Planning and Development Services
;Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
;Phone: (772) 462-1553 Fax: (772).462-1578
Building Permit Application
Commercial
Residential.
0
PERMIT TYPE: f'gr're, 0 ,
R.ROPOSEt -IM§PROVEMENT LOCATION .', : ' 4 i'„; . t. _'
Address: O n � �C 3 �� f"r-r 1 � v L ?�`
Property Tax ID #: 5Yo5 - -S"_04;L -®2-6 & - OOd! Lot No222re22�
Site Plan Name: Block No.
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Project Name: f__ tJ �'/ -
(DETAILED DESCRIPTION OF WORK pI
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65—f—t Glvoexl Atp ctu-ts es# 121-Je-e. 60/ode, o 6P 6I-i 22"
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CQNSTR:UCTION INFORMgTION
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Additional work to be performed under this permit - check all that apply:'
_Mechanical _ Gas Tank _ Gas Piping —Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 5-0 , Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE it r° s�
`COfVTRACTOR
..
Name AV V 5'�P_ - I0V't1'16'0
Name:
Company:
Address:
Address: 1010 -C4io 5'j
City: �/+ I er2te- State-
Zip Code: � -I t;L- Fax:
City: State:
�i
Phone No._� -,T 'KZi
Zip Code: Fax:
E-Mail: R-JNA1(,,C-011
Phone No
Fill in fee simple Title Holder on next'�age ( if different
E-Mail
State or County License
from the Owner listed above)
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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SUPPLEMENTAL CONSTRUCTION LIEN LAW INF0RIVIATIO'N,
LL
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
Stater_
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 UNDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig re of ner/ Lessee/Contractor as Agent fo Own r
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledgeddDefore me
this day of , 20_ by
O'k � " k 1�"% �Q ykm
thisday of 20_ by
Name of p on making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Procjjced
(Signature of Notary Public- S to of Florida)
(Signature of Notary Public- State of Florida )
ItAFitMNG
Commission No. #CGV O
Commission No. (Seal)
cfti' •A. MY
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�:De2p,2022�
REVIEWS
FROW��ERR'
RR
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
-T
COMPLETED
ev. 2/7/19