HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICgABL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (� Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Address: q0 7 gr,9L-J1e k s i reee
DEC :2 7106
Building Permit ApplicatioNrn,,,,n9Department
St. Lude county
Commercial
24 P. crce. y=L 3 `'I & 2_
Property Tax ID #: 3q Da `6D D —O 26 —06 U ` ;?, V_ ` U
Site Plan Name:
Project Name:
Additional work to be performed under this permit— check all that apply:
Residential r/
Lot No. 3U4-3
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $� �� ` Utilities: —Sewer. —Septic Building Height:
Name, NoWt -l.l 1--"4A&- e) f—L---) 611 Y5 W-M
Address: qu7 u, J usm ,'S4
City: ld!` 4fr'e r u , State: JEL
Zip Code: 3 Fax:
Phone No. 77,;,2. 5-7 7 ,� �D � I
E-Mail: r)/I� bl�itGfP�� C= !, nevi , C°Or�t
Fill inffee simple Title Holder o/ next page (if different
from the Owner listed above)
Name:
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.
Pitch
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPL'E,TITLE.HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
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 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 OF COMMENCEMENT."
Signat re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE.OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instru ent was acknowledge before me
The forgoing instrument was acknowledged before me
this6nday of &C 20 IN by
this day of 20_ by
Name 0TQrson making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
_
Type of Identification
Produced
Produced
(Signature of Notary Puf-li
I =; SHAHNAINGRAM.RAHMING
Commission No. ON#W275M
BondedIR S December20,2W
mm Nmary p� - Underwthm
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
e