HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Aa-usa-1
Date: Permit Number:
r
- 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 x_
PERMIT TYPE:—
PROPOSED IMPROVEMENT LOCATION ,'...
Address: C'? + �-
Property Tax ID #: '3 4 ng-(Do d - n I Q (W— Lot NoZR`�._,� _:12'9
Site Plan Name: Block No. �f
Project Name:
DETAILED DESCRIPTION OF WORK:s
L►v�+a 11 M P W On ( f I i r1L`bI,cr�T -)-rK I
CONSTRU.CTIQN,;INFORMATION:
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:: Sq. Ft. of First Floor:
Cost of Construction: $ 0,1LCY) — Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE: °
CONTRACTOR:"
Name bk,, � and , D_,Qb1 V)S
Name: ✓ i TO
Address: cP✓i fr r--
Company:, IM Exf-P.YIbY5
Cityr C-`e- State: �-
Address:
Zip Code: ifl Ta ° Fax:
City: Z6 LState EL
Phone No.
/1�a�
Zip Code: q 0Fax:
Phone No -7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail i Yl �'p C� i brex f P�:ors • L'41�
from the Owner listed above)
State or County License C AO> / 01,9 w-2
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.
LAWINFORM/�►TION
iStJPPSLEMENTAL=CONSTRUCTIONLtEN
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 Coun{v 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 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
commencing work or recording vour Notice of Commencement_
c
Signature f owner/ Less/Contractor as Agent for Owner
Signature of C ntractor/Lice a Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5T ? _ !At° JZ
COUNTY OF ST LuC) E-
The fo o�)g instr ent was acknowledged before me
this I 20� by
The forgoing instrument was acknowledged before me
this7i"day 17��h�1�-e1— 20j by
ay of
of ,
Name of person making statement
Name of person making statement
Personally Known _ c,X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
— Q�A_
Produced
-
(Signatu Notary Public- State of Florida)
(Si at a of Notary Public- State of Florida )
Commission No.
Notary Public State of Florida
ommission No. FjWORlitateofFlorida
. f Joshua Shane Alberico
My Commission
a Shane AlberiCO
��mmission GG 020879
�?o,oEx
GG 020879
Tres 08/16@020
REVIEWS
FRONT
ZON NG%
S I
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17