HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to 1 �(k�d Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: E �_CTIA 1 C/- k,
PROPOSED IMPROVEMENT LOCATION:_
Address: l/ 16121 C 1 k) J—
Property Tax ID #: &1 16108^ C 240 -ow- Lot No. 7
Site Plan Name:
Project Name:
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ `fJ-
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name '1GG I I -S LU'OD �►')G.
Address: a1--V-00ICoII _L, IPS ,r
Name: �Ja
Company: HCL+L.LJ0,., ElakiCaI Cu,)"
City: E4 , i'Jel'"' State: F
Zip Code: 3L1 q$ o1, Fax:
Address: 1010 77Ra
City: F--�' State:.
Phone No.
Zip Code: Fax:��l-�Co
E -Mail:
Phone No - ►- �-
E -Mail
Fill in fee simple Title Holder on next page ( if different
State or County License EC_A?)W 1 Ln�1
from the Owner listed above)
.. — v Uw..a 1 M\.LI VII IJ .7G7VV VI ITIVrtl, a mrs-unuru Notice OT 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
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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."
Signa t�0f Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF _s4, L_UCa
The forgoing instrume was acknowledged before me
thisday of I� 20 by
,�Go\e
Name of person maki7staement.
Personally Known OR Produced Identification
Type of Identification
Produced
- M cogo,�& (". 1pac t- DCL esu
(Signature(df Notary //Public- State of Flo da )
Commi t No G/ V .►*' N*,N�6$eah),blic State of Florida
Margaret E Montepare
My Commission GG 214990
REVIEWS I FRONT - T fdVirM`7 sn VI
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
SignatthA�of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF '�+. LL't C t
The forgoing instrument was a knowledged before me
this tac d1 ay of 20 by
carw0,
Name of person ma70R
tement.
own Personally KnProduced Identification
Type of Identification
Produced
(Signaturof Notary Public- State of Florida)
ItOmmission0. o N,ii f��blic State of Florida
Margaret E Montepare
'� My7:4 Commission GG 214990
�_ _i, c.,....__
PLANS VEGETATION SEA TURfiLEr �
REVIEW REVIEW REVIEW I REVIEW