HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(� ' I
Date: Permit Number: C�wa
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Building Permit Application FEB 5 2020
Planning and Development Services Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 �a
7-
PERMITTYPE:
U n tyr FL.
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ReSI
P ODOR@ 4MPROVE EN IN Mal a
Address: - �F / FL 15
Property Tax ID#: ��a�-- �s- ) cc 0�. Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE=�SCRdPTION OF WORK:
CONSTRUMOROI NFORMATION:
Additional work to be performed under this permit-check all that apply:
Y,Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing ` _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ !1 0(( Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name � Name: 14WIJ4. EC'r
Address: GE el t• Company:
City: L Stater Address;3//3
Zip Code: -Fax: City: ,.Y •�plPg!� { � State:/c/-
Phone No. Zip Code: 3.y 7�� Fax:
E-Mail: Phone No ?72 -M 2?
Fill in fee simple Title Holder on next page(if different E-Mail Alas '604—
from
Cry4—from the Owner listed above) State or County License 64 L JZS0_770
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 HMM10MOD
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 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 PN THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND O OBTAIN FINANCING, CONSULT
WITH Y R LENDE AN ATTORNEY BEFORE RECORDING YOUR TIC F COMMENCEMENT."
Signature of caner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF U**yaS_t_LQ
The forgoing instrumr�.e, nt was acknowledged before me The fo oing instrument was acknowledged before me
this'S day of �^2b 20�by this day of-6 24)L�_ by Name of person making statement. Name of person making statement.
Personally Known OR Produced Identificatio-n— Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
1gna ure oNiota ryP ubIic-St of Florida) (Signature of Notary Publi&State of Florid
•:»rs..3.���:mfn.7:+cz�.^-_�... ',:`�rT-:,,.s,.�w^,r`.r._+uwr•.
Commission No. ''' LASHAHN I M-RAHMING r'
I s v:;:.. :; ; �y J " LP.SHAHNA INGRAM-RAf� f(#)
My OMMIS��f#GG275060 Commissiar� N.o.-
v CO?OMISSION#GG 275060
EXPIRES:December' 0,2022 E;:FIRES: e
Cions N ° Lon:!i:d Th u Notary Public UndeWt,rs
REVIEWS F14b" ""- N SUPERVISOR PLANS VEGETAI"bjq NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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