HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Applicatiol
Commercial Residential
Address: a2 98._&1Le-b0.S/2. a4, d0dS Z-'CIS f/ Z''i W C�
Property Tax lD #: 3�1�(v �C� - ���-GCS � -C� Lot No. 8
Site Plan Name: q 8,SQ cc b o5 b Block No.
Project Name:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ %ry 73
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
X Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE
CONTRACTOR:
Name boArioCKi fly
Name:
Address: CS a R 8 SC�-ic7h T
Compan:de_ - � f �cars �C,
City: 90C A" IS-k• U_;!:L'__ State:
Zip Code:,3145__ Fax:
Phone No. 22) - u 79- 3 1 a3
Address:.3W r tle-5il e,?-1 21,1
City: _,;V1�rra 16eWZ -) Stater
Zip Code: 3,3LIO 4-1 Fax: 52a /L/l<o
Phone No jfo/-o2Gd-%L//
E-Mail: S-4fye-0 riioq-e-A 'e1.-.5&S,'--orf?
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 6U1.4 )e- Wide 107 Wi/7do �S,
State or County License.50-- %mil fS�J r'Z
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, 1 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
WI YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign of Owner/ Lessee/Cordr4ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO A
COUNTY( c��� i 1"sec �.47
STATE OF FLOR DA
COUNTY OF Pc_6A
The forgoing instrument was acknowledged before me
this (� day of 1 AA f -f i 20 d-a by
The fo oing instrument was acknowledged before me
this day of ik-,tt c t 20.2,0 by
2
Name of person making statement.
Personally Known Y OR Produced Identification
Type of Identificatro K
Produced A K1_! Ll'
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Corriissior r oues 04 18 20221
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Name of person making stater�t r c;;,,,,,,,;cn , GG 208493
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Personally Known OR`f\rodttcerf 11rtlf�cti�ri Cyrs no it
Type V'u
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Produced
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(Sig ture of Nota t Tbfid f"
Commission No. i�61;Z1 SZ191 (Seal)
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Commission No. (--'4468 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.