HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: ,�Toa" DO,-)
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
'I1-1-1 PERMITTYPE:
PR®POSED IMPROVEMENT LOCATION µ }
Address: - b % p 6 Pi�!'(.�'Y1%: r f k%j y For % Pw E rrc *FL- ,9r`ini, 1
f.
Property Tax ID #: 1 3 0 I 6 6 5- Z S d 0 0:�2 Lot No.
Site Plan Name:
Project Name: _
Block No.
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Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
Cj1NNER%LESSEE x Y M
CONTRACTOR
i
Address; � , f 5,� , „S cam" .f i"� G �. _ r'
Name: ✓Ji-i-
Cyrty//��(( �6Y�r�L�JC�:•`�' ,.. �i State:e.
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'Address ,�>c, ,.,,,: �c-.
, `��j°'r ,
�.�.�t�—,?"t$�•Mt4'Sj li+Jl�p'4•(�j J4�fM3
Cifj : Yyl li�1L!te
Zip Code: %1-71—
Phone No /- r-;62
hti�r FJ}�1'nl�ip�:.-
State:_
Fax:
2-I t7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County License
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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'1NFORMAT[ 0N:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: 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
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 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 TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of CYwner/ LVssee/Contractor as Agent for Owner
STATE OF FLORID!� . �
COUNTY OF II J C,
The f instr ent was acknowledged before me
this ay of 17 20 by
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification
Produced FC Dr'/v.es` • L ire e- -
KIM KEAHEY
1 0. State of Florida
(Signature of Notary it of
.,,, ���r My omm. x Ires Dec 16; 2020
14° �� it Bonded t u National Notary Assn.
Commission No.
Signature of CMtractor/License Holder
STATE OF FLORIDA
��.
COUNTY OF ��1 . I L�) Ca
The f�stru ent was acknowledg ore me
this day of � 20�
CA
Name of person making/statement.
Personally Known` OR Produced Identification
Type of Identification
Produced11. L,e-e„'r.,
(Signature of Notary P. e OhEtW9108 lic - State of Florida
• : : • commission # GG 024418
Commission No. My comn(Sfi plos Dec 16; 2020
Bonded through National Notary Assn.
REVIEWS
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ZONING
SUPERVISOR
PLANS
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SEATURTLE
MANGROVE
COUNTER
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DATE
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DATE
COMPLETED
Rev. 2/7/19