HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
WRIMN
COUNI
F L 4M R
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential V
PROPOSED IMPROVEMENT LOCATION:
Address: ' !�®S �Q,(,(� 0. �F'ngLa- i�'f icr-ce. FL-
Property
LProperty Tax ID #:(�I/®(r (0 b7' 0058 " vW " I Lot No. 4-
Site Plan Name: L/ CLKJ-- CJ bA. Block No.cp..-
Project Name: % P
DETAILED DESCRIPTION OF WORK:
►� �,MIT _F11jims
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters V Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
�
Cost of Construction: $ low, d
Sq. Ft. of First Floor:_
Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MBA SSQ T66sbo
Name: `JCY.t (r' FrozivL I
Company: efRk-Cte, l_O q;?
Address:1`j0ib5op4aCIQ fr& 3I Ud
City: I -f- T)crce- , FL State: _
Zip Code: 3��St' Fax:
Phone No.77 o2- " q-71 ` 113 ID
E-Mail:m>✓1ISSGL fOhnSOf)'tQ S-}'ItlGte-,�Cc .6
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: t TLLV- t. CDv�
r
City:yv eco 0-61 Bi66 r State: 9
Zip Code: -5�ll Fax:
Phone No �oI' �p `off" «4P
E -Mail 9PU1-I'Je-
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State or County License
IT vaiue or construction es ,-*ZSUu 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:
SIGNER/ENGINEER: Not Applicable
m
7Na
RTGAGE COMPANY: Not Applicable
Namdress:
Address:
City: State:
Zip: _!�ne
City: State:
Zip: P e:
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 NnTIrF OF rnMMFNrFMFNT "
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Signature of Owner/ ssee/Contractor as Agent for Owner
Signature of Contr ctor/Li ense Holder
STATE OF FLO
COUNTY OF CCOUNTY
STATE OF FLfl &'a—
OF
i
The f r oing in tri ent w"asr�acknowledged before me
The f going i st ent as acknowledged before me
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this day offs= 20"-O by
this J day , 20 by
Int 11_ssa 96kns OA
Y�
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Name of person making statement.
Name of person makings ement.
Y
Personally Known OR Produced Identification
ersonall Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature"o Notar �t1 nr+v
(Signature CTotary Public- Stateof da
Y P
,d Notary lI i CI or Florae
Commission No. Marybel Inez
V� Notary Public State of Florida
Ma bell M�
Commission No. :� ry )
e My Commission GG 270975
P d Expires 10/24/2022
my Commis$ n 270975
erw Expires 10/24/20 22
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
D.... 7 1
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