HomeMy WebLinkAboutBuilding Permit ApplicationAII;APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: Id-le-1 / Permit Number:
Building Permit Application
anning and Development Services
gilding and Code Regulation Division
300 Virginia Avenue, Fort Pierce FL 34982
hone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
ERMITTYPE: ,41, ,,In. �...,__
PROPOSED IMPROVEMENT LOCATION: q
Address: cJa `10� cw,,
- e4n t A_�t9.2
Property Tax ID #: I Lot No.
Site Plan Name C7 `& rd, Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
'CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
{ Mechanical Gas Tank Gas Piping Shutters
— Electric — Plumbing — Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
QQ1
Cost of Construction: $ v Utilities: —Sewer —Septic
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Z ✓v.
Name: S
Address: '�
City: J& State: FL
Zip. Code: 3YW7 Fax: ��%�
Phone No. W\ "►1"1 _05
Company: ,
Addres ;$``�/Ar
City: OJ. t"C `e__ State:l/ _
Zip Code:13Y?5-13 Fax:
Phone No
E-Mail ;All-d
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail r Q^0S le1—(2 %,w cz one
State or ounty License OCIV I/M
If value of construction is 52500 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:
EER: _ Not Applicable
Name:
Address_:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
C.
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
iniaccordance with the approved plans, the Florida, Building Codes and St. Lucie County Amendments.
e following building permit applications are exempt from undergoing a full concurrency review: room additions,
-essory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non=residential use
EARNING 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/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
:COUNTY OF�fl_„v
IThe forgoing instru t was acknowledge efore me
;this-: day of 20 by
Name of personVnaking statement.
Personally Known OR Produced Identification
Type of Identification
Produced
ature of Notary Public - ate of Florida )
Commission No.
MY COMMISSION # GG
REVIEWS; I FRONT COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF'
The forgoing instru t was acknowledged before me
�
this day of 201 by
Name of person ma ing statement.
Personally Known OR Produced Identification
Type of Identification
Produced
ature of Notary Public- State —of Florida )
ission No.
LASHMMINGRAM_RmMING
CLANS I V ZN C?y;'� PLA * GRO
REVIEW Elk : Bon 91 Rom./IEW
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