HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: R om • 60q(pCO
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 ✓
PERMITTYPE: Z owl
PROPOSED IMPROVEMENT LOCATION:
Address:i4q;zo Qd• N. Piu.-ce GC 31;9M
Property Tax ID H: 3 y ' S0 �2 - b157-OSO- i Lot No.q!v
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: ' Cut ,Sa i 1 n t t6ta PDD l C&iL ;4U
NFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
./Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft, of First Floor: _
Cost of Construction:$ 511t4 Utilities: _Sewer _Septic
—Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR':
Name 'L
Name:
Address: Jggo Cb 15�5w U.
Company:�ure
60/5 i✓rG.
City: PiGrG-- State: FL
Zip Code: JN 98I Fax:
Phone No.
Address: 9376
City: U.e o cA&1, State:FL
Zip Code: &1111,77 Fax:
Phone No IV — 59'i-79 5Y
E-Mail:
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail �ii1/ 1JS %A f btl �7 9ND1Q f %� CUhr
State or County License P-PPL5a 5r5y6lv,
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 LAW. INFORMATION:
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
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 Count makes no representation that is granting a permit will authorize thedpermit holder to build the subject structure
which is in con ict with any applicable Home Owners Association rules, bylaws or an 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 L R R AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF� COMMENCEMENT."
Signatyr of Owner/ Lessee/Contractor as Agent for Owner
Signature Contractor icense Holder
STATE OF FLORIDA
COUNTY OF Indic..
STATE OF FLORIDA
COUNTY OF T. dl Q�'ry
The forgoing Instrument was acknowledged before me
this __!J_ day of /ho.cl!% . 20 aF2 by
The forgoing instrument was acknowledged before me
this �, day of /H , 203LO by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification -)C_
Personally Known OR Produced Identification X
Type of Identification
Produced rOL
Type of Identification
Produced FGIJb
Eric Lutz
(Signal a of Notary Public -State of F Q' Ede Lutz
NOTARY PLIE
(Sign of Notary Public- State of FloW!STATEOFFLOI
LI
NOTARY PUBLIC;RCommissionNo.4r,)9s49h 11—STATE OFFLO
0FComm#GG1459
IBbmmissionNo.GG14Ti9`I 'Comm#GG1
1 Expires9/2
REVIEWS
FRONtr
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
IDA
14
21