HomeMy WebLinkAboutBuilding PermitAll APPLICAS�E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building ond Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential
PERIV11TTYPE:
LPROPOSED IMPROVEMENT LOCATION:
Address: I I '��o J�'� 614t
0 1 - 1 S-5-) - 00() -'�
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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I Moak on
Block No.
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
v/M'echanical GasTank Gas Piping Shutters Windows/Doors
Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3,7c)o -
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company:
City: L,-,cx-'k State: F(
Zip Code: ':��Jq-jq Fax:
PhoneNo.
Address:(�9rl �S�J'4
City: �'�c State: IF-
Zip Code: __S Fax:
Phone No J6 'I U
E- M ai 1. 6,7-c k' r-;>
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail --tov
I
State or Co u nty Li cen se CA C V6 1'� I (�O
if va I ue of construction is $2500 or more, a RCCORDED Notice ot Com mencement is requ i rea
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not A Yp—1 i c —ab I e
Name:
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: ,/Not Applicabie
Name:
Address:
City:_
zip,
Phone:
MORTGAGE COMPANY: V/ Not Applicable
Name.* —
Address:
City:
Zip:
Phone:
State:
BONDING COMPANY: Not Applicable
Name., —
Address:
City:_
Zip: —
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby madeto obtain a permitto clothe work and installation as indicated.
I certify that no work or i nstal lation has co mmenced prior to the issua nce of a pe rmit-
St. Luc! e Cou nty m a kes no rep resentation that is granti ng a permit wi I I authorize the erm it holder to bull d the su bject structure
which 'is i n co nf lict with a ny app] i ca b le Ho m e Owners Association rules, bylaws or a n 9 coven ants th at may restrict or proh i bit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
I n consideration of the Era nting of th is req uested pe rmit, I do hereby agree that I wi 11, 'in a I I respects, perf orm the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fo 11 owi ng b uil d ing permit application s a re exempt from u n d ergoing a fu 11 concu rrency review: room additions,
accessory structu res, swi m rni ng poofs, fences, wa I Is, signs, screen rooms a n d accesso ry uses to another no n-resi d ential 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."
Signat e of owi4nerlessee/Contractor as Agent for Owner Signature of ntractor/Lice e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTYOF
The forgoinginstrumeny was acknowledged before me The forgoing in5trUm knowledged before me
,�nj was ac
this,�gj day of ed�2r� 20,- thjsZ2dayof 1'eb[ix
20 by 2090 by
Name of person making statement. Name of person making statement -
Personally Known —
Type of Identification
Produced ::,:)I
(SignatureTf Kotary
Commission No-Ge
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
OR Produced Identification
Public-
FRONT � ZONING
COUNTCR REVIEW
EE�NANDO RETANCOURT
I ) C'Drl r1i issi�, n 4 GG I , 940AC
My Cc r-i r-. - Expi res V.P. r T ' . 2C
le tion I Nixary A
rc�tT, h N�tion -31 N i xary A
Personally Known OR Produced Identification
Type of identification
Produced 71—
n�-
igr6furj of Notary Public- State Co r�� j �'jo r. � GG 194(
Pi
tu Corrrn Mar 1
vV Expires
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I m m - No� t�. rcu g
mmission No.
SUPERVISOR I PLANS VEGETATION I SEA TURTLE � MANGROVE
REVIEW I REVIEW I REVIEW REVIEW REVIEW