HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 V/
PERMITTYPE: C-b Ucr
PROPOSED IMPROVE MEN LOCATION:
Address: )( hf \arl(-�
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
Additional 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:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name n n
Name: UUIC
Address: Y (-.o
��it5
Company: t(Q(1�' R o' k,4A. e'oaiY
City:R�eState: rL
Address: ����.�� Schle(cl'l2� L�
Zip Code: 3LAq $-_ Fax:
City: Qof! - St. �-1. A-e- State: FL
Phone No.nf�l 43:J-a
Zip Code: _2,54C4 �'Li Fax:
E-Mail:
Phone No 2t��J ��-_A- 3� ��-
Fill in fee simple Title Holder on next page ( if different
E-Mail �0,
from the Owner listed above)
State or oun icense��
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: lNot 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, 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."
Signature of Ow er/ L see/Contractor as Agent for Owner
Signature of ContraLicense Holder
STATE OF FLORIDA G, �OO
COUNTY OF / L � C�
STATE OF FLORIDA�
COUNTY OF /� �- U Lf
The Wyinstrume t was cknowledgefore me
this of 20 by
The #e�rgping instr �w acknowledgLi before me
this day of 20 /0 by
r ee Y d���
;��Cvrn� 1Cac�orowic2 Sr
Name of persorf making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identifi i r /`p
Produced J l C^
Personally Known OR Produced Identification
Type of Identif'catjQM `p t ��
Produced i f
(Signature of Notary Public -State of -Florida) -
MICHAEL MCHALE
Commission No. (Seal)- (
(Signature of Notary Public- State of FI rida )
Commission No. „^HAEL' (Seal)
'i.44fSSIG ;6
- "ES Dece
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
j
ev. 2/7/19