HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n _
Date: Permit Number: 3S5
u -
Building Permit Application
Planning and De velopment Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982.
Phone: (772)462-1553 Fax:(772)462-1578 COn1171e1'CIBI ReSICIE?f1t18I
PERMIT TYPE: -
Add,cess: AL M( n I Gyrlyz ( `P,C'V'ro a�) 3
Property Tax ID 9: ` y1 �W—lJC7 4 V`I Lot No. .
Site Plan Name:.S i�CIYN_C%A W,_e S (� )v \0 Block No.
Project Name:
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AddIitional-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::. "°70 Sq. Ft.of-First Floor:
Cost of Construction:$ W30 Utilities: —Sewer Septic Building Height:
Name (; vay les W RVOUy. Name: v r
Address: k7- f(Vlf�n't�C�, Company: C4i'
ty: . r�► I
Ci �,�VUZ Stater Address: 3 G- c-� C
Zip Code: ?X\0051 Fax: WA City: State: F(-, .
Phone No. 7 2u"3�P"10 ,52 Z p Code: ,3 �f�'�' Fax: '7�'" �
E-Mail: wVA Phone No�'�I
Fil.I in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State orCouqy 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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: s
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDAVIT: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
"1'I=ING 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 YOU OTICE OF COMMENCEMENT.-
Signature of Owner/Less Co rector as Agent for Owner Sign tune of Contr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF ;
The for oing instrument was acknowledged before me y The forgoing instrument was acknowledged before me
this day of ' 2pc` y this 1�J day of 0a 20�y
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification-9 'Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
I
(S tur of Notary Public- to of Florida) AJ (§g4atdre—of Notary-Pub. -State of Flor4ba)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED .,
Rev.2/7/19