HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED MM
Date: � 0 Permit Number.CJ!� co ' c
I
Cd
W N O
W Q U
- Building Permit Application
Planning and Development Services
Building and Cod@ Regulation Division a
2360 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 11<
PERMIT TYPE: r�1�
UUv a
PRO'POSED INPROVEMENTLOCATION -_ ,
Address: 2
Property Tax ID #:Qqd44q 03' Lot No.
Site Plan Name: Block No.6
Project Name:
DETAILED DESCRlPTION,OF VIIORK
F.r tiff
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CONS RUCTION INFORMATION I h, , ��'� �.'�-� U,� 4
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers Generator ItRoof Pitch
Total Sq. Ft of Construction: 1 'CYA Sq. Ft. of First Floor:
Cost of Constructio : . (, Utilities: _ Sewer _ Septic Building eight: _
OWNER/LESSEE - r 4
CONTRACTOR
Name
Name: k
Compa y:
Address: _J 11
City: �. State
Address. r
Zip Code: Fax:
C 1 t . State:
Phone No.
Zip Code: [, Fa Wo
EI Mail:
Phone No 2
E-Mail L,,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
SKe or County License
It Value Ot Construction is:1&)uu or more, a KecUKueu r4otice of commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGN
Name:
Not Applicable
ress:
State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:_
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Narne:_
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 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
commencine work or recording vour Notice of Commencement.
Signature of Owner essee/Contractor as Agent for Owner
gignature of Contractor/License Holder
STATE OF FL
COUNTY OF - ,
STATE OF FLO D
COUNTY OFJ�
The t5ping instrul e t was a know edged before me
The f oing instr • m t as ac cn wledg before me
this day of c 202Lby
this day 2 by
a
i
lardev of person making tateme t.
Name of person makings tement.
making
Personal) Known. OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produ ed
;(Signature of Notary Public- St ri iHERMN AVE%
(Sin eo Notary Public-
s°w ,w KATHERINE HAVENS
lPFY PV''Commission
2 e^ MY &¢S SION #GG165030
MMISSION #G9i;$66
MA}
No. ° ` RES: DEC 04, Pdi$
.
Commission No.
rough 9stSlai�Itis't>i`w
EXPIRE DEC 04, 2021
Ofi Bonded through 1st State Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
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MANGROVE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. v/26/18