HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
NIT:
j�?Y R7_
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Permit Number:
Building Permit Application
PROPOSED IMPROVEMENT LOCATION:
Address: e I �>
Commercial Residential
Property Tax 1D /- 70 ?5 " 0/3 " O) " 3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Ca2Ar°o'e� v Q
i CONSTRUCTION INFORMATION: I
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: Sq. Ft. of First Floor:
Cost of Construction: $ 11 too Utilities: —Sewer —Septic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name 42 1?1 (f1 C\-(f
Name: Owoo
Address: ig LzLe_kq- "l'_.
Company: 7�_" l` F C_,
City: v'Q � Stater
Zip Code: 01 Fax:
Phone No. ` ZY - 95 - - VS
Address /14 P�
/
City: P- w u la State:
Zip Code: L1 `7�} G Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail (
OAC L O cl � 0
State or County License c r-c Mlof o l!?. 1.
ki value or consiruction is: LSUU 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:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 YO DER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE -OF COMMENCEMENT"
Signature of ner/ Lessee/Contracto as Agent for Owner
Signature of Contractor/Lice a Holder
I
STATE OF FLORIDA f
STATE OF FLORIDA -'
r
COUNTY OFd ^ C
COUNTY OF
The forgoing instru ent was ar�lcnowledgel�efore me
this day of C' �',.r ;�20*fly,�-' by
The forgoing instr ent was ac�knowEedge before me
this y of 20 ' by
Name of person making st ment.
Name of person making state nt.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced.:-��
ignature of Notary Public-� Florida) Erik Nemop
(�' =
{Si ture of Nota Public- S 4 f Florida ]
Nerno1g3
S[Qi>ti �x�a t i�14Z`Eft(
Commission No. - � S
Res:
Commission No. ' ( ;isslpn # GGit#1442
Mn 4, 2021
af�
Bonded thr1 Aaron Notary,
Expires: May 4, 2fl2i
17,ui L
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