HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED L�
Date: ��vs 3.0 Permit Number: a21a� -031
_. 0 A p EFEB
ED
• 'C a%sk 020Building Permit ApplicPerm!,
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
PERMIT TYPE:
PROPOSED IMPIR E K4 E N A LOGATION:
Site Plan Name:
Project Name:_
�3 U 9-8 o I- 0o Ib - ouo-B Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
—Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_✓Electric _Plumbing _Sprinklers
a l,SgtFf'pf.Constructio wl I 0 6
_Generator _Roof , Pitch
Sq. Ft. of First Floor:
$ — J6 006.00 Utilities: _Sewer _Septic Building Height:
WNEWNIESM M
GE—) RACTO0
Name "06 HO ;
Name:
Address: I(Sl Erie,rml d AY a-
Company:
_
City: &r-r 10 i e r GL State: rG
Zip Code: `)`/9`IS Fax:
Phone No. 77,2 — S) 2 —3'4 ON
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 3A.hOeaPoetulzA.net
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 Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
BUIR PLIE MEN L GO T1 10 IE'N I
TON:
MORTGAGE COMPANY: _ Not Applicable
Ngme:
DESIGNER/ENGINEER: Not Applicable
Name:
Address: "�
`A`ddress:
City: State:- �j
Zip: Phone ' "'
@ity: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
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." f
Sign re of Owner/ Less a/Contractor as Agent for Owner
Signature of Cohtractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this '\"�dayof 20Q.aby
this_ day of ,20_ by
' � N }� k .5 J 4�0
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature o�blic- a� orida pEANNAMaZ1FTr"""�
:...., 0?10
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nature of Notary Public -State of Florida
a i ry
e},1• MY COMMISSION#CC
Docember i%202
Commission No. V'a� •; (51 RIRES:
• 66Thnt Notzry pubGcunde
'I? mission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW_
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z///19