HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Z- IS ZO Permit Number: QCC:ti
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Building Permit Applicatic� ��9��
Planning and Development Services t. Lucie county f
Building and Code Regulation Division
2360 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 1 Z,?) Zz ` Aay-bour P�i as
v
Property Tax ID #: _ y_ y2U -1601_ 0o 7-$ " OOQ=Lot No.
Site,Plan Name:' er Block No.
Project Name: s , V
DETAILED DESCRIPTION OF WORK:
Ell
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:
Cost of Construction: $ _rz t-7%3 • 97
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:.
CONTRACTOR:
Name
Name: \
Company: Ij
Address:fflbCEk�� A-
Address: C Y.
Cilty:5�-M)Ccy-�A Epyt Stater
Z ip Code: S0(42�1 Fax:
Phone No.=):Z- z ss' Q
E-Mail:
City: State:
Zip Code: qq LA Fax:
Phone No 9 I qq '
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 11 o a '
State or County License
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.
.�, `1_,.
` SUP 'PLEMENTAL 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
I 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
WI YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO OTICE OF COMMENCEMENT."
Signat a of Owner/ Lessee ontractor as Agent for Owner
Signa re of Contractor/License Holder
ST E OF FLORIDA_'' ^^,� J
C UNTY OF ,1"�fN/�
ATE OF FLORIDA �, n'
COUNTY OF
he forgoing instrume t was acknowledged before me
this day of ,-fL� 20 i by
The forgoing instrument was acknowledged before me
this , day of QZ 20_b by
J09 r_ZX eel
-
-) r<qn_�- !ALAZ:d,!�
Name of berson making s tement.
Personally Known OR Produced Identification
Name of p rson making stat ent.
Personally Known OR Produced Identification
Type of tification
Type of ification
,Produ ed
Produ ed
of Notary Public- S e o F o i
ig ure ofNotary Public- State of Florida )o��
),nkure
mmission No. _ G(No�tatPublic Stat of Florida
reer Bh ath
e` My Commissio FF ss27os
'?o�,to� Expires 02/18/ 020
p. Public State of Florid
C mmission No. a a
isa veer Bharath
oa My Commission FF 962709c`REVIEWS
JEA
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIONRTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19