HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
0
Planning and Development Services
Building and Code Regulation Division
,2300'Virgiriia Avenue, °Fort Pierce -FL 34982
Phone: (712) 462=1553 `Fax:.(772) 462-1578
OERMIT TYPE:
_PROP(
Address:
Permit Number:. ! 559
Building .Permit Application
Commercial. Residential
Property Tax ID it: 2-AV-1 ads - t'3to - 2-
LofiNo.
Site Plan Name: Block No.
;Project Name:
DETAILED OESCRIPTION O'F WORK:
\ OLGS I Urj. %k . •V&LlL --
I CONSTRUCTION' INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters. Window Doors
_'Electric` — Plumbing _ Sprinklers _ Generator \i' Roof Pitch
Total Sq. Ft of "I So Sq. Ft. of First Floor:
Cost"of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name or. s��:_��.�
q•.?��
Address:
Company: ,..t2c.� ��:� a•.ic <<
cityL-S
State: _�J,
.Address: SE 4 e z L � �
'Zip Code: S-Im b Fax:
City: Rit'r, . S.
Phone No.
Zip Code:Fax:
E-Mail:
Phone No _'l'l2-`io2(a_ i2Sc
Fill in fee simple Title Holder on next page (if different
E-Mall A�CWJ 9 K�'4S t�Ac-'�N
Aw A 9 r. 'e
from.the Owner listed above)
State or'.County License C:C1_
It value of construction is 5Z500 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 IN'PORIVN':
:. ,
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 be installation has commenced prior to the issuance of a permit.
St. Lucie Coun makes no representation that is granting a permit will authorize the permit holdelt to build the subject stricture
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, wails, 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
V"TH YOUR LENDER OR AN ATTORNEY BEFORE RE[oRDINC Yours iuencF nF cnmmFt4lcF5WF1UT"
ignature Owner/ Lessee/contractor as Agent for owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF �It 6
STATE OF FLORID
��.�
CV
COUNTY OF
The forgoing instrument was acknowledged before me
OXI DE_Lv_ f- ( ' 14
The forgoing Inspruipent was acknowledged before me
this day of n 20 by
this day of 20 by
Name of person making statement.
Name of person making stateme t.
Personally Known V OR Produced Identification
Personally Known OR Produced Identifications .
Type of Identification
Type of Idend tio�
Produced
Produced
(Signature of Notary Pu - Stat%,Wf It ids) AWRLOidJONM
Si nature of Notary P lic-State of Flo ' )
Commission # GG 13911
Commission No. S&WasSepWmbw29,2021
'Fov
. ComrimissionNo• "'�►�•. LAS HAH
�a
cto eonded Thry sudgetrrosa�seivioea
, •RAHMING
MY COMMISSION # GG 275060
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
`rROFa o�;,••'I
VEGETA Bondi ��
rZU.2022 .
COUNTER
REVIEW
:REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
.DATE
COMPLETED