HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
4 !
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
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: y(6 (A WN :. ,c
Property Tax ID #: Zr) 32— 500 - c0(o2-1000-1 Lot No. 1-1�
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
— Gas Tank —Gas Piping _ Shutters
Total Sq. Ft of Construction:
Plumbing _ Sprinklers _ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Cost of Construction: $ -150 Utilities: _ Sewer — Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name '5QY\tNrrti
Name: 3c)-\-t
Address: iLIW5
Company: GF_
City: ,.V.A Jc-fdc- State: F(
Zip Code: M-15b, Fax:
Phone No.
Address: 2-I2(p t)LJ A7Lrr_' JF_
City: L46 C State:F I_ -
Zip Code: Z`1065 Fax:
Phone No '54 _ZiZal
E-Mail:
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
E-Mail_j )p+ci. (' Coll
State or County License 3 ,114 %
�..a.—.,, a air��t�uL�sun M ?tZuu Ur more, a 11MUKutu mo=ice 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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,3ny 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 IMPROYEMENTS 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 Owner Lessee Contr
g / / attar as Agent for Owner
g
Si not a of Contractor Lice
g / nse Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORID
COUNTY OF � L A6&-,
The forgoing instrument was acknowledged before me
this day of 20 by
The forgoing instrument was acknowledged before me
this 31 day of jt � -Li1 20 6y
�I 0
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced identification_
Type of Identification
Produced
Type of Identification
Produced I_ b V
(Signature of Notary Public -State of Florida)
(S' atu of tary Public- S t f r'
Commission No_ (sea!)
► N tart' Public State of Florida
Commission Na. 1 ``�'1, h Bogert
` My commission GG 274003
s Expires 11/0512022
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REVIEW
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PLANS
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
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