HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
COUNTY
F L b R 10 A
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential
Address: -
Property Tax lD l#: )-SO<2 -�A kk- Oo orn - t��7 � - �,. - Lot No.
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
,z-Erectric
Total Sq. Ft of Construction:
Gas Tank
Plumbing
Gas Piping
Sprinklers
Block No.
_Shutters _Windows/Doors
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction:$ ;3cc oo Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: 1
CONTRACTOR:
Name Il-Gi'C'r-:Qcti,.e✓^e i rac _ 1�—
Address: 1 ',;x 101 -
City: i-�sr� �:_� ��... State: L_
Zip Code: 3`4 q 4 5 Fax: -i "! z - �;e I,
Phone No. - Vo ► - 5 ,7 t
E-Mail:0asror--,ejrr�._rnas�ryt% cow,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: r
Company: LL c.
Address:`,l--k Yla-
City: - ,., �t�cr, c "' State: F L
Zip Code: 31-k 61 S -1 Fax: --
Phone No.--5CDo--f30.s`�S-5-�33,
E-Mail
State or County License_ t! ez QS y 11�0 „_..
3 03 1 I
IT value or construction Is jL5uU 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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."
gnature of Owner/ Lessee/Contractor as Agent for Owner
gnature of Contractor/License Holder
STATE OF FLORIDASTATE
COUNTY OF _
OF FLORIDA
COUNTY OFIV C`t��
The forgoing instrument was acknowledged before me
thisp day }-.iL�_j
The for oing instru nen was acknowledged before me
of 2020 by
this day of 2Q ) by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known'' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
'��
(Signs ure of Notary Public
(Sign Lure of Notary Public- State of Florida)
MARfAH rtl! LS
Commission No. '.-Co11 3 GG 100722
MARIAH 1dltLS
Commission No. '"' Comtnis MOM
xpir2s June 3, Z021
Expires une . 021
cv A Tki Two Fain InSo;anrs 600-305- 19
� d"rrl=d T^.0 Tro,' I'a�n is�:aoae H00-335-7016
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19