HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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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 1�
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: D mr 4E 5j(lmix & -r 5r LJCI e rt!
Property Tax ID #: ! 6 Oil 7 t%DO
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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Z - 1`a/y 5 r4At r Coo l Idi1—g t5' Xw mwA 15'
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
X Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7i. `! Dh. b6 Utilities: _ Sewer _ Septic
_ Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 9-IJ1 )t C,4Ed Ar6t I
Name: 'zif$: , 6)UTA)6, a
Address: 7�:�jd A),01>
Company: P!o y yz C& iiu6 f l/Ne],
City: 13ptr S% Lt)G11; State: Fl-
Zip Code:,3[4-4 83 Fax:
PhoneNo.93O 54-0 1187
Address:,M NEd tYiLGG�dyITl1 �L_Nld�
City: n5 L . State: ��-
Zip Code:;TA6,&ii Fax:
-61
Phone No%� C(j�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License �Q� n 17 ZS 1
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.
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I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:.
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: _Not Applicable
Name_
Address:
City: Laty
Zip: Phone: Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and instauatwn as maicatea.
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 oriand 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
"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
.r . vnno r cunco nn Au ATyDFMEy REEORE RErnRO1NC YOUR NOTICE OF COMMENCEMENT."
i
Signature of Owner/ Le ee/Contracto as Agent for Owner
Signature ofaContrr/Licenseolder
STATE OF FL M A
STATE OFCOUNTYOF�u)l
!UC/fTL17C)
The forgoing instrument was acknowledged before me
The forgoing ins mentwas acknowledged efore me
s,Wdayof 77iC1�11lbfil ,20�by
this ,fjLd of�20 %�by
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Cr /% N
t`N me of person making statement.
Name of person making nt.
-'
9 rsonally Known %/ OR Produced Identification
%state
Personally Known V OR Produced Identification
g pe of Identification
Type of Identification
roduced
Produced
a
. ( ature of Notary Public -State of Florida)
(SignatuV of Notary Public -State of Florida )
ommission No. K "1 7V (Seal)
Commission No.9Y(76&r (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. z///19