HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 Vz
PERMIT TYPE: �i"�"lo
PROPOSED IMPROVEMENT LOCATION: 1
Address:
Property Tax ID #: LiH �50 - (po 1, - (!Q/7: UX0 -Q Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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I CONSTRUCTION INFORMATION: I
Additiioogal work to be performed under this permit -check all that apply:
✓Mechanical _ Gas Tank _ Gas Piping _ Shutters
'Electric �lumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
Cost of Construction: $ Utilities: —Sewer Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
�n
Name:_ 12\I
Address: 11'44 i',� A?W W(I C
CAP Tr , I
Company: 9 1) [GV1S{ (V(� i fN7 rt�TT{ tQ�
City: State: (
Zip Code: Fax:
Phone No.
Address:01(a'5Mt /7(%tpj Gi
City:e &—U:LI 13ttch Stater
Zip Code: ��/C%�i:z Fax:
Phone No-77,D-:al,90 TL114
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ffAUM N 04 OM( OeA. ✓LO-1-
State or County License_C GG 152070
n vdiue or conscrucaon is pzz�uu or more, a 14MUKutu 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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: u 10 (n(�` CA Address:
City: a, on } State: Jj. City: State:
Zip:�GPhone -7,731 q" 2,-O-�W7 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Zip:
BONDING COMPANY: _Not Applicable
Address:
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 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
PO D ON THE JOB SITE BEFORE THE FIRST INSPECTION. AF YOU INTEND TO OBTAIN FINANCING, CONSULT
W1JrH I(OUR LENINR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFLOMCEMENT."
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Signatur of Owner/ Lessee/ n ractor Agent for Owner
signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIC��,A�j,
COUNTY OF
COUNTY OF 1 tCCi��I Yl
The forgoing instrument was acknowledged before me
The forgoing instru nt was acknowledged before me
this I dayof�Orr�,2020by
this I dayofTl 20,20by
DraF 17fo2gA4
.4- lld&i25
Name of person making statemenfJ
Name of person making statement.
Personally Known OR Produced Identification
Personally Known L-'� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State of
for LISA B MO
jfA
H165imAne f Notary Public- State oIit&a)
COMMISSION
No.
MY COMMISSIC
'!EXPIRES Ap
-rF9a+752 �`EXPIRES AprilCommission
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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