HomeMy WebLinkAboutBuilding Permit ApplicaitonAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: LAY- ( �� T��ti 2`t y I`l 34r�52
Property Tax ID tf: 3L4vL - 500 y q - OW - 7 Lot No.
Site Plan Name: l n
/� n ! L � - ' �1'\]; Block No.
Project Name: V22-�1G-)
DETAILED DESCRIPTION OF WORK:
- PAw ' r 5 S C.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical w Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing w Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _ �(._, S( Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_;ic_rc h�1V i'(CiiJ ��tU IC,iiVyL
Name: ALIi�k.rA1f���rtfL C-O�"y'�}�1�2
Company: GMU-$_ A11f� C�iyiJrilC`�VfriiC,
Address:'7Sja,(L-_ K-40-ii:-.f)f- 1Z6
City: I RM 12 c _ State: F\_L
Address: 4 Wl 1V 9 \P1 _ ii '2
City: Vn State:
Zip Code: Fax:
PhoneNo. _�7 -I� tj
Zip Code: Fax.
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License CACA2 C)'3 ` :�
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 County makes no representation that is granting a permit wif! 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND OBTAIN FINANCING, CONSULT
WITH YOUR LEND AN ATTORNEY BEFORE RECORDING YOUR NOTI F CO MENCE T."
Signature of Ow or as Agent for Owner
Signature of Contr ice older
STATE OF t LORIDA
STATE OF FLORIDA
COUNTY OF iynArni J)fA6h
COUNTY OF nnIr-}rV11 1^3rAbk-
The forgoing instrument was acknowledged before me
tN
The forgoing instrument was acknowledged before me
,
this day of �1NM� 2020 by
this 1 day of ���4 20-W by
Name of person making statement.
-
Name of person making statement.
Personally Known _ OR Produced Identification _X_
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced - -anliNd'R
Si ure of Notary Public- State of Florida)
� �
[ ture of Notary Public- State of Florida.
n�"
.., l 3�
Commission No. � 7� C c{ {Sea!
3 m
Commission No. (4,2?0(gC1C1 (Seal�sx,
VIv N
vC1NREVIEWS
FRONT
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PLANS
VEGETATION
SEA TURTLE
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4E_VTEW_
COUNTER
REVIEW
AE\AE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19