HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 6 I I N l4
1
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
PERMITTYPE:
Address:-515-2-3 -J>10r-e [c�,Ve C&Y
Property Tax ID #: o3— rc•r a-,--3 Lot No.RQ4
Site Plan Name:
Project Name:
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ '-)'L400 oy
Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Block No.
_ Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE g
CONTRACTOR } 4
Name
Name:_z'Sc-�tf�
Company:
Address: SSZ3 i�l >� idJ�� cAv
Address: ?k ' 5
City: -fs- State: EL
City: 41- rr&=� State:
Zip Code: Fax:
Phone No. Scjz- 13s-7 �
Zip Code: Fax:
E-Mail:
Phone No
E-Mail -V=c oQC
Fill in fee simple Title Holder on next page ( if different
State or County License �-PG ft-e5»K3
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.
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."
Signatur of•Owner/ Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder
STATE OF FLORIDA \ STATE OF FLORIDA �
COUNTY OF Sy,Y.4 j rI)me COUNTY OF IS"
The forgoing instr����??en was acknowledgV
efore me The or oing instrument was acknowledgeA me
thiso` day of IVD 20by thi day off 20 i by
Name of person making statement. Nam f person making statement.
Personally Known OR Produced Identification' Personally Known OR Produced Identification` -
Type of Identification Type of Identification
Produced Produced
JnJQ66reSolf Notary Public- St of Florida) Q otary Public- S to of Florida )
Commission No. Commission No. (Seal)
: v"• "! ;:, LASWJMINGRAM-S SAW MO
aa• :;�F ! . ' : - cI ; LASHAH INGRAWRAH IN
REVIEWS Boni PuYItR PLANS E 7` :TIIk O � � 060 ANGROVE
REVIEW :;;, Q N EXPIR :DMWVA6,2022 EVIEW
DATE rzecc �,
RECEIVED
DATE
COMPLETED
Rev.