HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE;COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: - ��(��
RECEIVEDCOUNTY
F fe 2$2o2o
Building Permit Application PQrm;4L;
Planning and Development Services St. Lucy�,hty ment
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: _IWN��MA_A _
PRQPOSED II�iIPROU ANT LOCATION:
Address: )V3 �[`� S� V 1JJ2 '
Property Tax ID#: z a a �0 Iy G o G — �S Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE�SC �IPTiON OF WORK:
CQNSTRUCIT]ION INFORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$. Cl/)- y'S Utilities: —Sewer —Septic Building Height:
ODUNER/LESSSEE: CONTRACTOR:
Name p a / Name: Gam,/ //9�
Address: /.1''3 6 `7 7 J` �/ /�/ wf P-. Company: >° �v';"o `r/
City: Ps6, State:,L. Address: c� �� �� C e .Z ��� •� .� P/<
i
Zip Code: �Y 9�� Fax: City: '7-71C4 n 2 4— State: rL
Phone No. Zip Code: Fax:
E-Mail: Phone No '7 a – </ J G6
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Ca C a,S-7 4 1
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.
I
SUPP EME L CONST U • N I N LA ! FO TKJN:
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 thepermit 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 INT D TO OBTAIN FIYA ING, CONSULT
WITH YOUR LENDER OR AN ATTORNE FORE RECORDING OO OF CO ENC NT'
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Signature of Owner/Lessee/Cont ctor as Agent for Owner Signature of Contractor/Lice •Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF HJT" G� COUNTY OF
The fling instrument as acknowledged efore me The foo ging instrum t was acknowledge fore me
this /�rday of �! 20,/ by this �Dday of 2� r
Liam
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificationt— Type of Identification
Produced Ur��" Produced
V
(Signature `„ (Signature of N r Public-St of Florida)
,tI P11 ELLEN VAUGHN
'-State of Florida-No r�1� ublic ""P,
Commissio ._ Commission N ,.�o�P" Pie% ELLEN VA on # G 77 079 _* - e o Florida-Notar N
F oQ� My Commission Ex ires '- Y Public
P Commissio
October e• n # G
®C mmission E ires
REVIEWS FRONT ZONING SUPERVISOR PLANS V - 20?MAN ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW EW
DATE
RECEIVED
DATE
COMPLETED
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