HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 Commercial Residential
PERMITTYPE.
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PROPOSEDAM`PROVE MENT LOCATIONS.-
Address: I (A Ll _EnL)erne_ti LUoLu 3ugg&-
Property Tax ID #: Z ) - uQ;2- 0609- 000 "3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRLPTION 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: $ 12 10,'7 1.60 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE
CONTRACTOR.: "
Name'7'Yi.bma--64'5LtP_ Pai-i eij
Name:—, )P'V-eX,,1n_'k
Company: �R)$2 �Ki-f�:c�rS.ZhC
Address:lglay 1-_r.uev-r,_y4. QCw
City: F-6 L. State:
)
Addressgf�!
Zip Code: 04g3(0 Fax:
City: Stated Z-
Phone No.,
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail 1 yifr R) l 1Or;-e_x4ty,'Gr5 CGM
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.
�SsIJPPGLEMENTAL�CONSTRUCTjON
�
LIEN LAW INfORM�TiON
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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 apermit 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 Cbdes 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recordine vour Notice of CnmmenrPrnPnt_
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Signature f owner/ Less/Contractor as Agent for Owner
Signature of C ntractor/Lice a Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF :!5T Lucid GGUNTX
COUNTYOF LtAL /
The forgoQ�ing instrument was acknowledged before me
`f
The forgojng instrument was acknowledged before me
his Linay of ,/�e_en_ I-7-e-, , 201 by
this day of �_ �y.�.r . 201 by
Ai 'er>
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Name of person making statement
Name of person making statement
Personally Known _1c'- OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Notary Public State of Florida
Joshua Shane
ary Pub
(Signs=hNo.
�ssion GG 020879
{ g ture of Notary Publ - F �ens/2ozo
Notary Public State of Florida
6A'0
Commshurt�$hane Alberico
• Cbbm``rn Von GG 020879
Commission No.y (Sea
ON00 Expires 08/16/2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17