HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Co
pimp
urvTY YL O R 1 D A
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 Number:
Building Permit Application
Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:. O 5 i.,3a S Si a, br. r- .
Property Tax ID #: J`IGa' � 1 0 l 6 q5k- (56 0-) Lot No.�
Site Plan Name: L , Block No. S
Project Name: ('I l�l JAn
DETAILED DESCRIPTION OF WORK:
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FAR
I CONSTRUCTION INFORMATION:
t
710
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
_ Gas Tank
Total Sq. Ft of Construction:
Cost of Construction: $cg6
Plumbing
_ Gas Piping
_ Sprinklers
WA
_ Shutters
_ Generator
Sq. Ft. of First Floor:
M
Windows/Doors
— Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name AA VV\-
Name: C
Company: yO a.,O
s: 5 h � � � i-
Addres'
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CIL
City: 6LL: y State:
Address: 5-� 5 v-\Q S I a- L
Zip Code: 3 V ql Y Fax:
City: [;� L State:
Phone No. 712�761' �y�
Zip Code: NO Fax:
E-Mail:
Phone No - 3 ` d 94-f %
Fill in fee simple Title Holder on next page (if different
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E-Mail 0L!V►'►► 0-4,1 fei7C [ 44c (� qM < cry
from the Owner listed above)
State or County Licenseo2�3q�'
If value of construction is:>mmu or more, a KtLVKUtu Notice or commencement Is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL TAL CONSTRUCTION LIEN LAW INFORMATION:
OESIGNER/ENGINEER:
Name: _ Not Applicable MORTGAGE COMPANY:
Address: Name:
City; Add ress:
Zip: State: City:
Phone Phone: _ Zip: ,
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
L-" Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
`'Not Applicable
State:
Applicable
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
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/ Les e/C ntractor as Agent for Owner
Signature of Contractor/Lic nse Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF .S f L L" c : -1
COUNTY OF S-T
The forging instrument was acknowledged before me
= 202(, by
The forgoing instrument was acknowledged before me
thisa2 day of 1 by
this day of _A
LA p .20dL
�1 O--.CA O'er VAC - +
U� Y� %tlY� iGr�! C� (�
Name of person making statement.
Name of person making statement.
Personally Known c UR Produced Identification
Personally Known r OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State -of F r a
(Signs
"Y v� ,.. CINDY L ALCHERMES
Commiss Z - °C •. Late of F(�eal)
.Qi. CINDY L ALCHERMES
Comm sris •': Notary Public State of F lonoar al
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'�' Comm. Expires Jul 17, 2023
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Bonded through N
tional Notary Assn.
REVIE
SUPERVISOR
PLAN
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
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