HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: IQ, tc
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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
PERMIT TYPE:
Commercial Residential
Address: z r.L -MCMX W V>,R-. mgLA-t- a= Vz,,,,
Property Tax ID #: l 42-5 -7 o j 06 81 � o d� • � Lot No.
Site Plan Name: Block No.
Project Name:, 'Pir"ems. .
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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 ofConstruction: 1606 sip -;'/ Sq. Ft. of First Floor:
Cost of Construction: $ oa `� Utilities: _Sewer Septic.
Windows/Doors
Roof Pitch
Building Height:
Name its ®utyl.l,r`'(
Name:
Address: Z` (. 1`htV T1U b'. T��/aLU+ 'bf--
Company:
City: -71ttw.1r State: • `
Zi p Code 3y q f ei Fax:
Phone No. !oJ • �d % 71
Address
City:) i, ': State:
Zip„Code v ,�,16 :, ..Fax:
Phone No
E-Mail: Q.-9 Z9 S���ats:�ec�S�-M4�G"C�e�.e.�
Fill in fee simple Title Holder on next page ( if different _
from the Owner listed above),'
E-Mail
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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•th:at• may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed'for anV'restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree tlia'd I will, in all respects; pperfo.rm 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-nbn-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-YOURILE14DER-OR AWATTORNEY BEFORE-RECORDING�YOURt NOTICE OF COMMENCEMENT:"
Signature,of Owner/ Lessee/Contractor as Ag nt for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA .
STATE OF FLORIDA,
COUNTY OF
COUNTY OF
The forgoing instr ent was acknowledged before me
The forgoing instrument was acknowledged before me
this \1� day of 20�__ by
this day of 20_ by
Name of person making to ent.
Name.of person making statement.
Personally Known OR Produced Identification--
Personally Known OR Produced Identification
Type of Identifi tion
g`• Y�.a5 ::1
Type of Identification.
Produced �- '�
Produced
wlic-
j.
(Signature of Notary P State of Flori )
(Signature of l\lbtary,Fublic=,State&TYorida )..-
Commission No. a�'�`'�Pb:;(�NAINGRAM.RAHMI
(Co' mission No. (Seal)
•: *: MISSION 0 GG 2750
:; '.F. • eQ: EXPIRES: Decerar 20 20
MW Notary Public U-
REVIEWS
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REVIEW
REVIEW'
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19