HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
Building Permit Applicationn
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
12:101: "6144t&121 0 9us]Ll
Address:
Property Tax ID #: A�21 - 0-3 r 610&2 Lot No. d
Site Plan Name: A j/," h la eJah �' Tyre Block No. 2Z
Project Name:
DETAILED DESCRIPTION OF WORK:
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
Total Sq. Ft of Construction:
Cost of Construction: $ LV
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name '
Name:
Address: 2;L2'7_
City: at�--t sf State:
Zip Code: Fax:
Phone No. 1"2 - &"JoO — - �
Address:
City: 4f23'� i. /lilF�
Zip Code: Fax:
Phone No,g42— -, C-- 26A %
State:L
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail Czea4 1115-� 9 C121) 14
State or County 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.
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:
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 thepermit 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 BEFOKE HLLUKDINL IrUUK NOIILL OF LUI1 MMLEINENI.
Si of Owner/ Lessee/Contractor as Agent for Owner Sign~ Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIg� 1
COUNTY OF 5'T LyciLL Cog COUNTY OF `-JC1C, Cou 1�1
The forgoing instrument was acknowledged before me
this_7 day of MAAc_+i 20 r -9V by
TE-(< AL,nnetd
Name of person making statement.
Personally Known _, i -I / OR Produced Identification
Type of Identification
Produced
�ty��lY1�A�.� l./�Gl"J�rPll✓
(Signature of Notary Public- State of Florida )
The forgoing instrument was acknowledged before me
this day of li►ARZ14 , 20Q2 by
Name of person making statement.
Personally Known✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commissi
H
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Commission No. (Seal)
`l,l Yllll,'
,State of Florida -Notary Publicif
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REVIEW o�°�' yp%kq sion Exp}EAAE
DATE
RECEIVED
DATE
COMPLETED