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
Address: oC
Property Tax ID #: I-) I —�
i t _ Block No.
• iYi Arm=71f, .
Project Name: _
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank
Electric _ Plumbing
Total Sq. Ft or Constru::tion:
Cost of Construction: $ Q_ ; __
_ Gas Piping
— Sprinklers
_ Shutters
— Generator
Sq. Ft. of First Floor:
I/ Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
Name-'
Address:�
Cit\/:�_��I State: OL[
ZiP Code: 3 �[ _ Fax:
Phone No.—
E -Mail. —
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:_ )jjXLI1fI#
Company: MM &1*pLSG I P.�eUcixd- MA Rec�5lcw
Address: 110 6 'rerhill4l k b0 DO'
City: h'►Aw. }Wrb ,- Pjeaclk, State:rL
Zip Code: 3ag3"I Fax: Sal-'71-)-'Fa34-
Phone No -7-7.A -337- 44170
E -Mail S'L ms (Z) UIeUSfOrIr�► •�-'�' -_
State or County License 00'317 -- —
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
if vaiue of HVAC is 57,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: ^ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Namer
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. Lucif. :o4nty !rakes no representation that is granting a permit v,/ii: 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,
acc,s:or strucr.ure s, swAriming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNINGTo OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWI'�E FOP IMPROVEMENTS TO YOUR PROPERTY. A 1VOTIICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIYH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Cwner/ Lessee/Contractor as Agent for Owner Sign- ture of Contractor/License Holder
STATE JF FLOi6LA STATL OF FLORID
COUN rY OF 6 /, C'�
COUNTY 11=��-- --- — -
The for�oing irstrr merit was acKnow egged uefore me l 11L� fo uing iristr mens was acknowledged before me
� day 20� by
this day of 20 by this of
Name of person making statement. Name of person making statement.
Person4diy Knowr.,-._ _- OR Produced Identification Personally Known _ OR Produced Identification
Type pr iclenvficat+c-, Type or identification
Pro ucr�d..._..__
(Signature of otary Public- St to of Florida ; i Signature otary Public tate of Florida )
Comrnissio No. �� 'w!_ Commis n NOGG �S v*�,Wr\lll:kA/
e
� ANotary Public State of FI rida el
i
— --�-- --- —
EM." commission GG 15 970 �'oi a 10/18/2021
REVIEWS FRONT Z fl�tlf'�490R PLA S VEGETATION SEA
1
COUNTER I REVIEW REVIEW
DATE
RECEIVED
DATE --t—
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CGMPLETED
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