HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 j 1 Z1 2-0 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
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 101 1 Ne_b `e.5 h1 V 8
Property Tax ID #: -' S501 -Sa 1 - 1 305 - 000 __ 9 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
- -R16-o ik-c c_�5 a Q cal: f or" N+_e-- ' -r
a k-e- -Jpor- l.i tt_e..
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric ,Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 4 2_17_6?(z7
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Y
Name
Address: 1
Name:Mcky-ffyi Gcur' C-4, Ier
Company: T-nr)QVA+VC_ PfQM604 d'&rC "A
City: ����r Sic L_yc� e. State:
Zip Code: 2)q 5 -7 Fax:
Phone No. 3c - Z1 - 10 8 %
Address: i 7 S fix, t Sn i� i�� 0'r,
City: PD(--)- St Loc�e State -FL,
Zip Code: S4q,5Z Fax: 170-075 5-3 �f 2)
Phone No -1 -1 a_-343� — _SZ-7--Z
E-Mail VWAri1:zrc, Lou I n_od 6Gt+1
E-Mail: M rS r)ARh e t"Yl2 ;caw►
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License G FG f H �� 3
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 I MORTGAGE COMPANY:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City:
Zip: Phone:_
_ Not Applicable
State:
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 kFNDER QR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
re
STATE OF FLORIDA
COUNTY OF i �=
as Agent for Owner
The forgoing instrument was acknowledged before me
this f 7--day of 20 2,�l by
Name of person making statement.
Personally Known I
Type of Identification,'
uced IdetvtWigatiQig —
Notary Public - State -of Florid_ a
Commission # FF 971317
My Comm. Expires Mar 14, 2020
Bonded through National Notary Assn.
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Signature of Contractor{Licdrise Holder
STATE OF FLORIDA
COUNTY OF j"a_-
The forgoing instrument was acknowledged before me
this day of r--1 207f-' by
Name of person making
statement:
Personally Known V IR"U-ced ldLntificatioq:i
Type of Identification Q _
Produced Notary Public - State of Flori
• = Commission * FF 971317
My Comm. Expires Mar 14, 2(
} Bonded through National Notary As
ature of Notary
Commission No.
State of Florida )
(Seal)
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