HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential
Address: L40 ( l c mI 6ey "• , -FDrj t'i erce r FL_
Property Tax ID #: 230CI- 31 L4 - Q000 _ 000 -g Lot No.
Site Plan Name:
Project Name: LV
Block No.
DETAILED DESCRIPTION OF WORK: \ , -
f29191CiGe 20 wi nJ wS +- 12- doo/-S i Z�-For -S 2e- vim) Ty` k rwPctc-I—
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical
Electric
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $ 31,3(43- 0o
_ Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name cTyI�2 Aria L_ubsKv
Name: PO.b�
Address: L40( Co'M II QJ.
Company: T�e Qe4o�
City: Fol-t-�?a^c� State: �
Zip Code: 9L49t-1,6-- Fax:
Phone No. 772 - 5 - gT66
/nNome_,
Address: 2L,1_ 5 faLe,,� F<,Kr4 (2cl.
City: Ai I ds-- State: f%` -
Zip Code: 3303 ( Fax:
Phone No 75�(- 22ei 26I
E-mail: IybafSk\lG-)aI Low
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-mail
State or County License CUC- 1622717
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.
SUPPLEIVIENTAL 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:
BONDING COMPANY: Not Applicable
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 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sc n+- Lucie_ COUNTY OF in l- L_Oci e—
The forgg�ng instrunmentffwas acknowledged before me The forging instru ent was acknowledged before me
this ZIday of _fes {�r�r 201> by this L day of 202a by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public gnature of Notary Public- St" a
e, TIMOTHY R. O:MALLE
// // TIMOTHY R. O'MALLEY / MY COMMISSION # GG 11
Commission No6610)15' _ _ 1,4S&PyUSSION#GG 11713 C mmissionNo.Gp��?�3 - =Se a
-
EXPIRES: August 7, 2021 ' `> Qer<�PIRES: August 7, 20:
% Bonded Thru Nota Public H - li Unde
Bonded Thru Notary Public Underwriters Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED