HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
BUiiding Permit Application
Punning and peveupmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34982
Phone: (772) 462-1553 Fax. (772) 462-1578 Commercial R
L
MITTYPE: A-p� %, l fll1l'
POSED IMPROVEMENT LOCATION:
Address: -7 % r�c' (
Property Tax ID #: 3 �t -a 5 bt)o-�
Site Plan Name: d o 0 GL IyLX' 4
Project Name: i %i �- r rt H O C m
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
61
Doo �p
e NIP,
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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 of Construction:
5q. Ft, of First Floor: _
Cost of Construction: $ ' 5 0 Utilities: _ Sewer Septic
OWNER/LESSEE:
Name
Address: e�L
City: State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: b�
Company:
estdemial--J(
Lot No.
Block No.
a
— Windows/Doors
— Roof pitch
Building Height:
nc
City: `' State:
Zip Code: i�—J
Phone No
E-Mail t (A _ u5
State or County License A} 1'� t�� C
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: Nat Applicable
Name Name: Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE MOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Add ress:
City:�
Zip:
Phone:
UVVNtK/ LUN lI KAL-FOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 Horne 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 RaEtnRnINr. Yn[ rya NnTIrF nF C0?A EiuCFmr-wr 11
Signature of nW Lessee/Contractor as Agent for Owner
Signatu e a ntractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFPAtAlaFAcH
COUNTY OFPALM BEACH
The for ping instrument was acknowledged before me
The forgoing instrurjient was acknowledged before me
this day of (n , 20- by
this ja- day of � IX - 20. J q by
D 1 A-M U A-P-AA
RD 12. }2�C 4&"- -
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
(Signature of Notary Public- State of Florida
nature of Notary Public- St f Er'
fl �a� nLa Not�Fy Public State of Flori(1
Commission No. FF9769I o 4�(59�hSilleAli-Amrat
n N1y Cvr>zmissicn FF 9769�P
4 %,xf PUg Namry Public State of Florida
Cc5nmisslon No. FF976919 Y =n ram:
fi� (&�}Ali-Arnrai
a a Niy Commission FF WTS11)
9iFp F`oa Expires 431.M2020
~�` 6F 4o Expires 03130/2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Nev. G/ 1 1 J.tj