HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO �MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h
Date: Permit Number: VCO�.I__/D
Building,Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential -
PERMITTYPE: PmOI,-b-Q h
Address: /0851 ''5. , Oce,4n
T Property Tax ID #:. 5-11 r 0l o-
Site Plan Name:
Project Name: 2 .
C@ - RUCT,16 NWEIMr, ATIOIN"
:
.Z Je4 fpl
- 000 l _
'GL. 39193,-7
Lot No.
Block No.
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: 7U Sq. Ft. of First Floor: ,%p
Cost of Construction: $ /700 oo Utilities: ewer _ Septic Building Height: ls
QWNEPP,II S'� E,
CONTRAC t1R:
NameArlBS d`` fdS�iyyn �®J Q0'a'on
Name: M
Address: �fi s i�7�
�l
Company: aryt �7��ioOc47i
1
'/
City: A,ISGfc,(Ine9dit'' ` . "' State ,IV
Zip Code:
Phone No. J��6: 9%?" g��y
Addres-sT bol
City:1--* l'SP4 A, e7 State:.
Zip,'Code:f" 3y%7 ' 'Fax:77,z-�3� 2/9�
Phone `No 77�0."�'�
E-Mail: —
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-M"ail tLdtz. r `Y*
QO .Cori
State or County License csc
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 UKNSTRUCTION LIMN 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[ 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 L DE R AN A BEJFORE RECORDING YOUR NOTICE;OF WMMENCEMEJVTe2
Signature of Owner/ Lessee/ ontractor as Agent for Owner
Signature of Contractor/License der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S�\r�CCc^�Q
COUNTY OF
The f oing instrument was acknowledged before me
day ��Rn��n� 20D_b by
The f�rgoing instrument was acknowledged before me
_K day )rY\Q_&a 20gko by
this of
this of p�� ,
a6�
kN1
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
JID�re.,fNota�wy
Public= St , of Florida ), .'
igna ure of f�otarY Public fate of Florida )
.��
Commission No. �: *.m.;� z �Se�al
Commission NI.ASI3�iiNAINGRgM
,P;
•�: tASHAIiNAINGRAM-RAHMING
ING
5Z I.i`r ((JIMISSION GG 275060
t ==':>
az..';:.f' A
• .;; EX
REVIEWS
{. T
I:ROI T �
;` ecem
5060.;�7hru
R
PLANS
VEGETA�"f� '
No nder
22
JAGROVE
Cf3tP"
wPu
REVIEW
REVIEW
REVIEW
IEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19