HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: e -f9 Permit Number: d
IN -
Building Permit ApplicatiorIment
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Per St. � gle County
Commercial i( Residential
Address: /0/0 2 S' Ocorrj 2w, S-0,T.-
Property Tax ID #: 41T`0 Z 30Z - 00g6_ 000-9 Lot No.
Site Plan Name: GYAW5 Block No.
Project Name: G yoa�
DETAILED DESCRIPTION OF WORK:- - -
�y"(C*w E S pmi T-aL
CONSTRUCTION INFORMATION:
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:
Cost of Construction: $
o1
Zp� c�
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C /'Q (v"04f6a, Ltc
Name: Mid- Ga�1
Address: ✓a 7D.(
Company: tel: &4 -?c�hGE{
1J%41` 1-V14fZ
City: fMA,140,16 State:.
Zip Code: 3 23 Fax:
Phone No. gf y- 6 9 - 7p y
Address: %'fid Al,*1
fr y
City:
Zip Code: f1 c1 g
Phone No CI Z 01)
State:
Fax: & Z
&/ 0
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
' E-Mail
State or County License
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not � Applicable
Name: OW49
iG�OS
Address:
City:
State:
Zip: Ph ne
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Z)ip: Phone;
,BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 pook1B3THE
w Ils, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FRECORD A NOTICE OF COMMENCEMENT MAY LT IN YOUR PAYING
TWICE FOR IMPROVEMENTSR PROPERTY. A NOTICE O�COENCEME T BE RECORDED AND
POSTED O JOB SE FIRST INSPECTION. IF YTO A FINANCING, CONSULT
WITH YO LENDER OWANEY BEFORE RECORUIN _Y ENS"
Signatu a of Owner/ Lessee r
ctor/License Holder
STATE OF FLORID
=OFDA
��il
COUNTY OF
COUNTY OF IWVL
The fnor, �oing instrument was acknowledged before me
this 1� day of }J DU +� , 20Jj by
The f ggse��ng instr e t was ackno ledge before me
this 17C/day of 20� by
L C \�i�-�-�. _GW &U� T. )
I 1 i Q_� V �
Name of person making statement.
Name of person makin statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatio
Type of Identificati n
Produced
Produced
(Si na re of WtarlW
State of Florida
(Sign toe of N ry Public-
Notary Public State of Plor�de
tary Public
Commission No.gels ��
Commission GG 235102
Z tap
Commission No. eta fission GG 235102
pires 0710412022
Expires 0710412022
nor
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2-1713.9