HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE.-m:,MPLETED FOR APPLICATION TO BE ACCEr7 cU
Date:
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:
Address: 45dO N PWi AYA
Permit Number: (:Q W-5 'cas-(�p
Building Permit Application
Commercial Residential ✓
Property Tax lD #: l 1{l4 — -76`f - 00/O - D00 8 Lot No. 11/
Site Plan Name: 6W6f 1S /SLAiOD /02ES EYZI/F Block No. --A
Project Name: AC,QJdV /STA
No
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:
Cost of Construction: $
Sq. Ft. of First Floor:
AooD. oo Utilities: _Sewer _Septic Building Height:
Name V6A)VWAN 4DAVtV1S-17ZAi7e)N Lt(
Address: -? f O 60, 05F'z c5
City: MIAM I- :. , - - - . - - `- . State:
r
Zip Code: 53 114 -, . Fax,:,
Phone No. -7T6-'Sl9 y'pD`f�8y0
E-Mail: MOv-feAol (� 514 v 7ovn25 CP7i✓1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: kebtAODO IZFr6 7PL,000
Company: 41Z7X!2- C406T/Lr d7W D 11-C°
Address:- /-' 360 SeD q0 57-.
City: MIAMI State: _�L
Zip Code: 331.7-5 Fax:
Phone No -7Rb-3q'V--�305-5
E-Mail rP-W -(�W04 -4,1 kco, C ovn
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.
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
Address:
City:
Zip: Phone:
BONDING COMPANY:
Address:
Zip: Phone:
_Not Applicable
OWNER/ CONTRACTOR AFFIDAVIT: 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 conAct 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."
o
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractorr icense Holder
STATE OF FLORIDA
STATE OF FLORIDA I
__�pp
COUNTY OF Cf C 1
COUNTY OF �a'kil
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of ��P by
th' _ day of 2o_ by
I Q�'/�26a
\I 1 C � V C� l _ A- _ C iA
\
�, MyC1 ,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
1
Personally Known OR Produced Identification
Type of Idnation
Pr ced
Type of Identification
ced
i
JJ
( ignature of Notary Publi -State of Flgnidey DANNA COLD a of NotaryPublic- St a of Florida )
y :.....
,L O�l�y Commission A SO 25 804
Commission No. "i II "•
EXPIRES: August20, Mmmi •. LASHAH-RAHMIN I)
�+?or pops° BoeEeGThm BuEgelNotEty "was ;.;•`.,; MYCOMMISSIONSGG275060
••
•o";°•' Bonded ThruN Publk UndenMlersMANGROVE
REVIEWS FRONT ZONING SUPERVISOR PLAN
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.