HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED. '
Date: - �� � %��.0 � - � Permit Number:
Building Permit Application�'�;�fjo
Planning and Development Services yPP oA ��1p
Building and Code Regulation Division my°
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential,
PERMITTYPE:�e�t�`i2����
PROPOSED IMPRUVEMEN I LULAI IUN:
Ad&e"ss:
Property Tax ID #: . Lot No.
Site Plan Name: AIC E G✓ ISM Block No.
Project Name: A/O" iZcS t !f' f e5 '
DETAILED DESCRIPTION OFWORK;-
CONSTRUCTION'INFOR MATION:: s
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank'' �' _ Gas Piping _ Shutter's _ Windows/Doors
[Electric _Plumbing _Sprinklers Generator- _Roof. ', ,' Pitch
Total Sq. Ft of Constructions: � Sq. Ft. of First Floor:
Cost of Construction: $ 1t U v r Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
I.Name - . 0 -&. ! %'� i~,,
Name �-
_ `/ S/ 5 % 10111 r r�l (S t
Compa:'
t &I
�Addres's''
City �on� 5�%ter LSD! State:
Address"ww
j
Cit I State:L
Zip Code: 330 Fax: Q, ✓-3-5 -31IS-1
Phone No —' T151:9c�
nn
Zip Code 3iaY9 S3 : F 3x i1772- Q73- o G 7 7 i
Phone No. 9 Ssr- 3 Z_ S-` / 4 9
E-Mail: ''rya e / i� Fatdd a'r7. r 5s: c o r t
Fill in fee simple Title Holder on next page (if different'
E-Mail - ' l
State or County License 4
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION''LIEN=LAWINFORMATION:'.-
DESIGNER/ENGINEER_:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: -
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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.wgrk and installation as indicated.
I certify that no work or installation has commenced prior to the issuance'of a permit.
the ppermit holder to build the subject structure
r and,covenants.that may restrict or prohibit such
aed for any restrictions which mayapply. ,
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 accessoryuses 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 pf Owner/ Lessee/Contractor as Agent for Owner
Si ature of Contra r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA� ''
COUNTYOF Fr. LN cI?
COUNTY OF Z Lµcrt
The forgoing instrument was acknowledged before me'
The forgoing instrument was acknowledged before me '
thlse1Z dayof TArJ0AA4 ,20 Zo by
this d7 day of ZTAIN-+A^i ,20'46 by
/I%D,P C Akea
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known /OR Produced Identification
Type of Identifications -' ,
Type of Identification
Pfbduced
Produce
tL) V
lJ
(Signature of Notary Pul
i_ �� ��f�N blic•Seate of Florida
(Signature of Notary Publ
,fit „� Fl�otery ublic-State of Florid
Commission No. G� 3
=• ;�= Commission N GG 366648
?; My(1'>�)'nission Expires
July 18, 2023
•,
Commission No.6G3S
= •= Commission A GG 366648
F�e'� MNeai%nissiori Expires
•nnn`� July 18, 2023 .
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