HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2-1 k t Z-0 Permit Number:
J
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: ploy, 6i et
PROPOSED IMPROVEMENT L(YCATION;
Address: 3 i b Y ApP ca ch S h Q+ Wa-tl
Property Tax ID #:`" J� 7Q ? "` / % "d ®�? Lot No.
Site Plan Name: b') kLS 4 7- _S�L 2 AJA_14 G(-U45 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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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: $ 2-:2-5,5 - 00
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name v Njor4eA
Address: 310L1 A�p J0 1 V
Name: Mow-4-In ��aryipt"'
Company;TYI lfiVA;bye.-FiuPA�
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City: St L;3cd State: FL-
Zip Code: _3`JR62 Fax:
Phone No. 1 l Z -375 - 96., 5 3
Address: 15�5 7 5-e Sg(` ., C� C 1 r
City:,_tlexr--5,- _Ocic State: FL_
Zip Code: 349 51 2 Fax: -772 &73 3�!,k 3
Phone No-1`1 --15�-,•7 ---_5-2-2-Z-
E-Mail: K4,II1' 0C/R
a 6) VCt.hcc
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail i_ II2 tk
pttirn hew . `
State or County License`s
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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 INFORMATION:
DESIGNER/ENGINEER: — Nat 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 Home Owners Association bylaws
any applicable rules, 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 14ENDER QR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign re o O r/ essee/ ontractor as Agent for Owner
Signature of Contractor/Li nse Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The forgoing instry ent was acknowledged before me
The forgoing instr4ment was acknowledged before me
this tI day of 20W by
this h day of �'-e-�avc�� 20 2V by
Name of person making statement. I
Name of person making statement.
Personally Known ` ,QR—Produced lderytifikaxiQ@t
Personally Known NR"u'Eed idtntif catio4a -
Type of Identification _°� `` Notary Public .State of Florida
'Type of identification _ L
Produced • •= Cammission # FF 971317` '
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Produced '�'+ ° Notary Public. State f Flori
�� My Comm. Expires Mar 14, 2020
'' °FA�d`4�
' 3 Commission # FF 971317
,__ 7 - Bonded through National Notary Assn.
My Comm. Expires Mar 14, 20
�.of c�.�
0
F
'� Bonded through National Notary Ass
fR.
(Signature of Notary Public- State of Florida)
(Signature of Notary a lic- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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Rev. 271