HomeMy WebLinkAboutBuilding Permit Application Ala -IT)b U4
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDy�
Date: Permit Number:
A RECEIVED
-- Building Permit Application FES 2 8.2g2o
Planning and Development Services Permitting Department
Building and Code Regulation Division_6g�is Cou6jY
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSE:D !1VIP`bv- 'ENT,_LOCATION v
Address: C7nS�D
Property Tax ID##: j�?,�, `"' 00 3b r C� ) o aZ Lot No.
Site Plan Name: Block No.
Project Name:
DET'AhLED`DESCRIPTION 0F-WORK
CONSTR 'CT10N,INFORMATION ,
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric _Plumbing, _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ( (7 (7 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: = `CONTR/ACTOR
Name zA UC (pkf4,e Name: J
Address: a Z ;& Company: 40M5;�_::a,.0 .
City: Sta ( Address: t{`k 11 1"res5�
Zip Coder Fax: City: :E3= Q-e T, State: Utz
Phone No. Zip Code: `?qI Fax:
E-Mail: (iy Se o23G o 9- [ Phone No )7)— —�)k. SS S
Fill in fee simple Title Holder on next page(if different E-Mail (.f W n C a �4-
from the Owner listed above) State or County License :22
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 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 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 O essee/ as Agent for Ow gnature icense Holder
STAT LORIDA ST OF FLORIDA
COUNTY OF CI- L�- COUNTY OF Lac �t
The forgoing instrument was acknowledged before me The=of
nstrument was acknowledged before me
this `day of -mon,-N� 20� by this 20,a by
Name of person making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
e of Identification Type of Identification
'Pro uced Pro ced R TJ lqp
ca
;'1iature of Notary Public-State of Florida) o ignature o Notary ublic-State of Florida) i;i; rncmission No.6C- 2 b ( (Seal) �s m N IT; Commission No.C,-& agLi(S (Seal) a r oCr
Z A
REVIEWS FRONT ZONING SUPC�PdI A LAMS VEGETATION SEA TURTLE
COUNTER REVIEW R VIEW REVIEW REVIEW
DATE = N
RECEIVED
DATE
COMPLETED
ev. 19