HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO
�JMUST
/BBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 �fi'�!� Permit Number:
A R E
_ Building Permit Applic tion FEB 12 2020
Planning and Development Services
Building and Code Regulation Division Permitting Deparb—nent
2300 Virginia Avenue,Fort Pierce FL 34982 �, U l e r.,,/ y
Phone: (772)462-1553 Fax: (772)462-1578 Commercial n ,.. I
PERMIT TYPE:
/— V
Address: &/0Gf�l �✓ �(�f� /e,�C1� FL A/792
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
«WRACKOR :
e3 A 4 e !"'A'
ONS ON ,O A ON
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Yfriumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: �1 Sq. Ft. of First Floor:
Cost of Construction:$_ 7 y Utilities: —Sewer —Septic Building Height:
W CSU R •R:
Name om NA G I Name: IV A
Address G, Company: lI/Y
City: ,D C,j State: .— Address:
P
Zip Code: I G�9. Fax: _ _ - City: , '- [' '( •, . State:F
2 .
Phone No i7? Zip Code:' Fax
E-Mail ~; Phone No �` - -
Fill in fee simpletTM6 Hoiden pn next page(=if different E-Mail f� ' 110A 4 A404f*
from the Owner listed above) State or Coun icense
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. p �f
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. /� I
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SUPP NTAL CO STRUCTION LIEN LAW INFOR I � N:
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 AFFIDAVIT: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 Owner/Lessee/Contractor as Agent for Own F Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA /. % °
COUNTY OF '�;e COUNTY OF t (, i( e
The fgr9 ing instrume77t was acknowledged before me The fprg�ing instryzae t was acknowledged before me
this day of U 20W by this day of nT�II e/ , 20 00 by
421/4 S,4/;,/I
Name of person naa A g statement. Name of person ma statement.
PersonaFno n OR Produced Identification Personally Known OR Produced Identification
Type of tifi ti Type of Ident fic ' n
Producet Produced ►� '
G ,
(SiRa�tu(ree of Notary Public-St f Florida (Sign ure of Notary Public-St t Florida )
Commission N ;j �
/�D��(� Commission o.� Se I)
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REVIEWS SUPERVISOR PLANS VN �00
1� GROVE
NTER REVIEW REVIEW REVIEW Bonds Thnji 23 VIEW
DATE
RECEIVED
DATE
COMPLETED
ev.277/19