HomeMy WebLinkAboutBuilding Permit Applicationi
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED fan
Date: . f �' �� Permit Number:
�. 1A 'AlunoD @iDnl 'IS
� w.. y
Building Permit Application 6102 8 1 330
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982x ; .
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi a �+aFt � b, lbs 160
PERMITTYPE:
P,ROPQSED IIVIPROVEMEN:T LOCATION:,
Address: ��Lk S 5 6.rr'
Property Tax ID Lot No.
Site Plan Name: 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 _Windows/Doors
.&Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
0\NNER/LESSEE ;CONTRACTOR
Name r\ Name: ��
Address: -5 1.— � civ Company:(,"mac fA20-AQ
City: o�`��c� State:i=L Address: 2C,-?� 'fC�r�f��S '}Y
Zip Code: .3 4-('P5( Fax: City: 41- 1215-=� Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No -77Z—�/�' 1333
Fill in fee simple Title Holder on next page( if different E-Mail_ -6JC .Q coo
from the Owner listed above) 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.
4`« -` �. try �.G�t � �� ,r.._ ,{zzRtr 'r '� Y�° * "`S £' � F��.� ,.� `�sd��'� � �-s-"�•�`�.x`'--{{ �� "s RMS <)?�' !!�[EITL£ N'SF�2k �s iONtN�ll ��1RI1T�fl . x �
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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
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 IMPROYEMENTS 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 COM ENCEMENT:'
l l�
Si atur f Owner/Lessee/Contractor as Agent for Owner Signatur f Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OFCOUNTY OF
The for Ing instrument was acknowledg d before me The fo[going instrument was acknowledged before me
this day of 20 by this�Jday of^�(_�20Z by
Gly L UU ► ) � Oq/YS-� Q � rA A h,
Name of person making statement. Namea of persoh making statement.
Personally Known OR Produced Identification / Personally Known OR Produced Identification/
Type oKfdtli ication Type of Idents#' ti n
Produced Produced LC _
(Signature of No (Ir (Sig ature of -
is�?y AUDREY B.HUMPHRF.. •.... AUDREY B.HUMPHREY
Commission No. �`�: I �r;^;t7 Commission N `� �'
*: OMMISS�i ��G.. _ : _ COMMISSION#(l�T8a�p617
aQ EXPIRES:March 6,20'%3 "r !! �,�: EXPIRES:March 6,2023
mm—PANI � ii•7i•�,��a' Pwid.,dThriMptacy ublicidererilors
REVIEWS w FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19