HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLET" )R APPLICATION TO BE ACCEPTED 4- J
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
PERM IT TYPE:
Site Plan Name:
Project Name:
Permit Number: 7003
Building Permit Application
Commercial Residential
05 Ll/z/fl), 0.!91
RECEIVED
MAR 2 5 Zpo
Permitting Department
St. Lurie County
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _Windows/D ors
Electric _ Plumbing _ Sprinklers _ Generator _Roof�Z +.Z Pinch
dotal-Sq�Ft'af-Cori4fr' c� fin AIPa Sq. Ft. of First Floor:
Cost:ofXonstruction.i$g�`71'S00 Utilities: _Sewer _Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
ame 0 Gg?
S
Name:
p
ddress• s 1C A ;c1
Company,
ty:
i Code: p 310196 / Fax:
P one No. '777— Z3 0!1
StateF`
'Address: `
City: State:_
Zip Code: Fax:
Phone No
ail:_0D. eaW
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencemerit is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: City: State: _
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 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 16
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
WIbH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
-
S S3�- 2Q2-57-Z87- b
gnaYSr 'of O eT/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY
COUNTY OF
OF I'L 1 G
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before
me
this day of 20_ by
this day of�j�e&� , 20,�Q by
_
6n&h e Sc.,
Name of person making statement.
Name of perso&1making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced :Z) 4�_
61a�� 4VIZ
(Signature of Notary Public- State of Florida )
ommission No. (Seal)
(Signature of Notary Publ' 'State of Florida) g;::"'�
h0.'
y
;s
Commission No. (Seal)
-
''"'"n:
v,
REVIEWS
FRONT
ZONING
SU„$
IX
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEWl
REVIEW
REVIEW
REVIEW
REVIEW
DATEc�
o acm
RECEIVED
.
mo 0, :5
DATE
Nx'GM
COMPLETED
Rev 2/7/19 l