HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED • : •
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Date:
Permit Number::'
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-Building Permit Application
Planningand' Development Services
Building and Code Regulation Division_
!'2300 Virginia Avenue,. Fort Pierce FL 34982 _.
.Phone:.(772) 462-1553 Fax: (772) 462,1578
COI'1 the1'Cial Residential._
I�PERMITTYPE:
'PROPOSED IMPROVEMENT. LOCATION:
Address:. U
Property Tax ID #: �� -Li ZG - U 0
O 0 0 'r `- Uy —
Lot No.
Site Plan Name:
Block'No.` '
Project Name:
;
DETAILED, DESCRIPTION OF WORK: '
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Itpl
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ GasTank _ - _ _ Gas.Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _ ` �' - Q6 -'Utilities: _ Sewer _ Septic-' "Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name AA 41-6,A�7 � �''r� Cr
Name: F iG
Address:_[ 2-3Z . He6ur .- R � e 61 V } . :'
Company._ .i �nJ ;` +n c -
Address. 3:S U .�.
City: ��f_•�Vl G;�- V State: �L
City: °'Ro f.{-.'Stater
Zip Coder 9 9 0 : , "Fax:, -t .
-Phone'No. - . _ Y ..
Zip Code _
E-Mail: - _�
Phone No: 7 72; L`6 e"- csa0.
E-Mail ' VV �P�(U i G� ua16 , GdNi
Fill iri fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 52500 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 INFQRMATION.
DESIGNS
Name:_
Address:
City:
Zip:
Not Applicable
State:
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
Name:
Address:
City:
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 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 consideratiori'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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S o.M- Lv t-+c, i COUNTY OF sa.M4- L-u Lip- Lok)m-y
The forgoing instrument was acknowledged before me
this 244,day.:of' .AmvuO 20_10-by .
F�1L L'l413v�tne1-
Name of person making statement.
onally Known OR Produced Identification
Type of Identl Ication
Produced
_1Y A
(Signature of No 7'y
'�A �ublic State of Florida
Commission No. "Woollt aIj1missio GG 45665
�� Expires 02/26/2022
The forgoing instrument was acknowledged before me
this 2�+ day of l cA"wYr ; 20 2 0e by
r f-i: c,,:: - L ear u nnc o.0
Name of person making statement.
Wally Kno n OR Produced Identification
Type of Identification
Produced
(Signature of Notary Yublic- State of Florida )'
i
Commission No. Notary Public Sty7�7
Chris L WoolleMy Commission
aw
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Rev.2/7/19 - ..