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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 2 ©or,�)'Unqz? Building Permit Application Planning and Development Services Building and Code Regulation Division - 2300 Virginia Avenue, Fort Pierce F! 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia PERMITTYPE: Address: 12 07 /Jy, +Ya Jl 6M 0LP- 1 P Property Tax ID #: 24 33- 801 00 4-S 00(� -3 Lot No. Site Plan Name: Block No. Project Name: Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank —Gas Piping _ Shutters Electric lumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: _ o tv Windows/Doors Roof Pitch � Cost -of Construction: $(�Utilities: —Sewer —Septic Building Height: NEW NER/LU-6`5 C®NTRACiC1R• Name-l�l�)£ p�,OU>I�i� Name: Address: PO BOX IS01 FP 9 Company: City: r P state:F1 Zip Code: ` 4 Fax: Phone No. 12 bs Address:'' City: State: Zip Code:- Fax: Phone No E-Mail: LaD-'�'cAwcp be goA•n Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail 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. SUPPLEM MAMMON LIEN LA 1 FO MATION: 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 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." Sign JU>wner/ L s ee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thiP\-_ day of Yy\o , y, , 2017by this day of 20_ by Name of person making statem t. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced 'FL �fi, Produced f (Signs ure of Nota Public tate f F r' (Signature of Notary Public- State of Florida ) = LASHA-INA))I�NGRAM-RAHMING Commission No. COMMISS$A)#GG275060 Commission No. (Seal) EXPIRES: December20, 2022 REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE ZONING COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. Z/ // 19