HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Building Permit Application
Commercial Residential
PROPOSED IMPROVEMENT LOCATION:
Address:,-
Property Tax ID #: o y - ®D i y - ® 00 s�
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
IA -C i "* i&V ?
M
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ _000 , po
Sq. Ft. of First Floor: _
Utilities: —Sewer _ Septic
W
Lot No.
Block No.
U
Windows/Doors
Roof Pitch
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name r1a ✓
Name:
-z'
Address: It '7� Z
Company: s -F 44 4_C
6C"14"
City: Aln Drees, State: CT
Address: 19,17 SI -J
1�a���,"l�;��,,Ie,
Zip Code: Q (, SF ? D Fax:
City: /� �4, 1_�.r
" o _Stater
Phone No. 7712-
Zip Code: .3V.912 Fax:
E -Mail:
Phone No (77_-,)) 3 7
E -Mail
- 9194o
Dt7o Ca
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License"S"3
it value of construction is $Z5oU 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.
MENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/E _ Not Applicable
MORTGAGE COMPANY: Applicable
Name:
Name:
Address:
Address:
City: State:
t State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Appli
BONDING COMPAN Not Applicable
Name:
Name:
Address:
Address:
City:
City: _
Zip: Phone:
Zip: Phone:
VWNER/ 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 BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign - iare of Owner/ Lessee/Contractor as Age-61,for Owner Signaillure of Contractor/License
STATE OF FLORIIPA I STATE OF FLORIDA
COUNTY OF i LA,(X'sz COUNTY OF V`t k)UQ-
0
The forgoing instru en t as acknowledged before me The forgoing instru ent as acknowledged before me
this �`l� =day of & 2090by this day ofY401 by
Name of person making statement. Name 0 - person makirIg statement.
Personally Known _i OR Produced Identification Personally Known _�,/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Flo
Commission No. G1C`1)w-7Cs)_
d 911X_�
David Raymondpggnature of Notary Public- State of Flor' David Raymond
NOTARY PUB IC /� c _ NOTARY PUBL
STATE OF FL i mission No. G-1 d 7 o I STATE OF FLC
Comm# GG28 52 ": Comm # GG287i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED