HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Iq 11'�0 9
Building Permit Application
nning and Development Services
Ming and Code Regulation Division
70 Virginia Avenue, Fort Pierce FL 34982
one: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓
PERMIT TYPE:
PR'OP.OSED IMPROVEMENT LOCATION':
Address: -0 05 H5-15" COKEt 'V�E= POyt S-•
Pr operty Tax ID #: �✓��JS� - Od J bo - oOV "�O Lot No. I I
Site Plan Name: Block No. 04%
Project Name:
I
CONSTRUCTION INFgRMATI,ON:
Iditional 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: _
Cost of Construction: $ (000
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Building Height:
OW ERAESSEE ; _.; ,
CONTRACTOR:
Name Nam W I III AW 'Qmptte'r
Name: Z W-le,10 r: 1,itAM4
Address: FiWiVP t 1. Sf,
City: Port SY. (.M tie, State: _
Zip Code: 34 A'?�3 Fax:
Phone No. 11�7.11G M -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company: C VI�bWtPA M4M0W UP FIVI(VU,
Address: 7-059 4tFtu *W+, 614i+e- I
City:yli ly Ae k State: R-
Zip Code: 374[f-t Fax: 417-•7-7-& 50" 41
Phone No +17- 747-0
E-Mail Patel P�CWaF(Orl da(vIC�CV'WI
State or County License U7% 1 019--3I 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
el.
SUPPLEMENTAL CONSTRUCTION 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.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St 1 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.
Inconsideration 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
00WARNING 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 JQB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT4agh LENDER OR AN ATTORNEY BEFORE RECORDING YOUR'IVOMICE OF COMMENCEMENT."
Signature & Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY
STATE OF FLORIDA
T-M;h4
OF :QdA All ?AV(1V.
COUNTY OF I40�1,--
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this IZI��day of NDyMMI,iV , 20V11 by
this ��iViay of N0Vee1Wt9A' , 20 del by
Name of person making statement.
Name of person making statement.
Personally Known I✓ OR Produced Identific
4
Personally Known V" OR Produced Identificati
Type of Identification
9
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
>
(Signature of Notary Public- State of Florida)
_ cn
Commission NoG"CT-"% A 3-::L (Seal)
Commission No.GG'1 ;)3%% a- (Seal)
� 7Q
i
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
,DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19