HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZA Permit Number:
ERECEIVEDding Permit Applicro 0
Planning and Development services mitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential f/
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: 930N-31)I—OD 16-000—$ Lot No.
Site Plan Name:
Project Name:
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction: -I p bi0
Cost of Construction: $ *moo()
_ Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof . Pitch
Utilities: _Sewer _Septic Building Height:
OWNERNIEESSEE:
CONTRACTOR:
Name Ja-cob Yephini
Name: '
Address: ti 5l Ca,eatl d AyF-
Company:
City: For7- Pi C/c e- State: _Eti
Zip Code: IYVIS Fax:
Phone No. 77d- Sd?-;qP4
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: JID DP a 0)he-11 SDL,ti, •4 j-
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.
UPPLE E L C. U
ION Lit N
0 ON
MORTGAGE COMPANY: = Not Applicable
e`a .li
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
ia�
'Address:
City:
Zip: Phone
State:
dip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
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."
Sign,affre of Owner/ L see/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thiVtl day of 'ice , 20b by
this _ day of 20_ by
P
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 3�-t—pt
Produced
(Signature of Notary - MRIEc�
(Signature of Notary Public -State of Florida j
oEANNA
'°"P�'"'•"'•IB ONSCG022020
Commission No. &i.= MYCoMM�G �,Yj
Commission No. (Seal)
- tuber 16.2020
EXPIRES.
BondedTlWNotz y?Ublic Unde
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev. Z///1`J