HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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 't-�'
PERMIT TYPE:
Address: uACCe\ '05A— -1
Property Tax ID #:
Lot No.
Site Plan Name:
Project Name:
111 ww��
Additional work to be performed under this permit —check all that apply:
"Mechanical Gas Tank _Gas Piping Shutters
Electric
Total Sq. Ft of Construction:
Plumbing Sprinklers Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof Pitch
Cost of Construction: $ � S. '5- 0 C D Utilities: Sewer Septic Building Height:
Name ?�_, ..7,11, C Name: L2� kVi Yy-\ CC
Address: (_C,./-\ Company:
-
City: e/ L..Q. State: Address:
Zip Code: Fax: �11,
City: C�yy-\ State:
, (::�, ±�_J
Phone No. Zip Code: Fax: 9D- S"D
E-Mail: Phone No a.a
Fill in fee simple Title Holder on next page if different E-Maila L"n
(_ -
from the Owner listed above) State or County License C..tq- C, A. S1 co/_� ICP
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.
..r r,.a _: - ili r...........
,,,��,„ m C,01���'RE�CTIOI ml.lEN LAW w�Nhry�C�ftMA lC?�V r� ���';
fl'��� x. �P;
{�,Ah il�"� �"1�_��vi�
DESIGNER/ENGINEER:
vrvt-0ull
Not Applicable
- L�'I��I�1� i'"" a k!I���""��I'�ii�l'`�f
�Ii� �•,., ���Flk.
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
structure. Please consult with your Home Owners Association and review our deed for an restrictions which may apply.
I . such
Y Y Y pp Y
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/ see/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF- IA - 9=-=\
COUNTY OF " i
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of .�� -�,,, , 20 ( by
this day of ,. , 20 1 7 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known FOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
a y
(Signature of Notary Public- State of Flo oia)
.C.-
Notary Public- florida
(Signature of State of )
Commission No. ++•��aY p'�pal GINA M. KENYO
�M � )
406_AL'MIL
.�'"�-GINA M. TE'Ny'O'N
�0.�'1 ssion No.
(Seal)Notary
F
Public - State o
* Commission # GG 015542.
V4 ``,,�PaYp��,�i-
on a #`'� = Notary Public - State of Flo
Commission # GG 0155
'�°F �`'�•+ B
n I
tat s
of �,.�¢ . YCOMM.
Expires Jul 25,
REVIEWS
FRONT
VEGETATION,
and
��tary
tl�?EM
COUNTER
REVIEW
REVIEW-wr
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.