HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
•
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 Number:
Building Permit Application
Commercial
Residential __ _ X
PERMITTYPE: A-tJ/ -on Eiacf ` chann"5'
PROPOSED IMPROVEMENT LOCATION:
Address: lit U
Property Tax ID #: 3 'T c)-A 5qbDo-1 0 DD Lot No.
Site Plan Name: ((t NLP_'_ T Block No.
Project Name: (n e. ta-&S ff S if ou'e
DETAILED DESCRIPTION OF WORK: I
kAo- of - �'U tj fq C U n .
Cioc) rriian iq S-ee(-" 5 jA� t-k-)
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. $ _acn $ , O
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ST
Address: eC1
Name: DPW K6W
,+n
Company:
_
In6-
City: State: A
Zip Code: 303a (_p Fax:
Phone No.
Address: 91D
wArd 1plaa__64
City: to P 6
Zip Code: C
Phone No /
State: FC
Fax: 5 a rr . 7 i-166
C7 O
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above]
E-Mail /l -
r-0 t L ( t - c o
State or County License
iT value oT Construction Is W:)UU 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 MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip; Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip; Phone ---
Not Applicable
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.
1 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE Oh COMMIIENCEMENT "
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Signature of CtwnW Lessee/Contractor as Agentfor Owner
Signatu e o ntractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFPALmBEACH
COUNTY OF. PALM BEACH
The for n'ing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
this 7 day of :-- r 20� by
this jZ day of - - 4'Yi er 20A by
D A Yet. u+Prp—HrJ
Name of person making statement.
Name of person making statement_
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
awy,"', v —' L�x
(Signature of Notary Public- Strofrida
_
nature of Notary Publics t f I` r'
FF9769i9 NAo8t�'1ry Public State of Florid
CDmmissiDn 1110. SafRIIIEAli-Amrat
FF �?69ip
ata�Y P4�� Notary Public State of Florida
C mISSIDn ND. FF97S919 kCpAli Arrrrai
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ommission
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pCes 0913012 20
; FLo� Expires 03130,2Q24
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19