HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '� Permit Number:
-m FAPR
D
COUNTY
Building Permit Applicatio
PRO
20
Planningand Development Services Pfitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCA ION.
Address: O')P- W
Property Tax ID#: 1y2,S; — 701 ' 016 310 — % Lot No.
Site Plan Name: eskvvf{tiq-ems Block No.
Project Name:
E AI�LEaD Di=�5CR+1'PTION OF WORK:
KEwo Ul L [
czv
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: Sq. Ft. of First Floor:
Cost of Construction:$ 1060 ® Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: IT] "R,
Name Name:
Address: 2707do . 14
10�1.• Al u,tt!!r r_ Company: ,
City:M� %&5i S Stater Address:
Zip Code:q'C/94//9 Fax: City: State:
Phone No. d ,5�/–;2J57 5'�7F5 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 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.
S 'F, LEM �N ANL CONST LlCTION L LAW I RMATIO
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:` Not 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 restri'ctibns 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 acc'ssory'uses to,anoth&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 LEND ER.,OR AN-ATTORNEY.BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
VV
Sig, ' ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF_Q AC(`e COUNTY OF
The forg i g instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this ay of n1 IU') 20�y this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 1V63 C 1ld-C Produced
i natur of Notary Pu - t e o�F A i CATHERINE JIMENI!2(Sigr ature of Notary-Public-State-of Florida)
f °m Notary Public,State ofFlorida'.'
Commission No. !al) Commission#GG 92121Cbml nission No.
My comm.expires October 18,2023
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DATE
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DATE
COMPLETED
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