HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
C0UNTY
a t
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential i"'l
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
ririrncc- vL yF�-', U [^0 iM iM r-) AJ i r P,
Property Tax I D #: A��Otl ocel - 010" Lot No.
Site Plan Name: Block No.
Project Name:
DETAILEDg�DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: i
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank —Gas Piping Shutters _ Windows/Doors
Electric 1/Plumbing _ Sprinklers Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ - Utilities: — Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR: j
Name 't". sue.
Name:_! MYAV S-70'YAAA,,f'
� C �y1vC�1 Address: �
Company: _3JG
City. F uL_ State: �"�
Zip Cade: ,3�/`i` � , Fax:
Phone No.
Address: ( �jW V-NA- JDV"Y IAV!
City: 'Rc%�r J_a='E State: 'i L
Zip Code: 3;_/` y6, Fax:
Phone No 7V--7 77- 00/0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ei.i�`' � VyWA ° o fk�iw. c"'Dyo
State or County License C-(U
if value of construction is SZ500 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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
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 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, 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 rt our Notice of Commencement.
Signature of Owner/
STATE OF FLORIDA
COUNTY OF
astAgent for Owner
The fpr oing instru was &c oWledge¢ before me
thisCk_ y of �J#{ lY ` 0,A, by
4'4(Uma -
Name of person) m} ing statement
Personally Known , OR Produced Identification
Type of Ident�at�
Produced
Signature of Contractor/I,iEeny Holder n
STATE OF FLORIDA /;
COUNTY OF�v % .. � (s tie
The f"ing instru was a kryo ledge] efore me
thisaC /. day of VIU 20 by
Name of person aking statement
Personally Known OR Produced Identification
Type of ldentificatior�
Produced
ignature of Notary PubliIZ(�atrAifJk'>i Jft) 00 ^ (sig�rature of Notary of FloricUk Namoga
t±�6t011J1� # uolsslluwo �`nftiComllniSSIon I GG101442
Commission No. �Ijni►��N 1p, (Sea, ".,, � Commission No. = Exp �y 4 2021
Baled thru Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS [VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -- — _..._.
COMPLETED
Rev. 8/2/17