HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED lJ
Date: 3/502,0 Permit Number:
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---- Building Permit Application otot i �dv
Planning and Development Services 081119Z3 r
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential f✓"'
PERMITTYPE: SAt�cl
Address:
Property Tax ID#:NIZ4e7- y32- ooZS -coo -o Lot No.
Site Plan Name: Block No.
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:0 (2 0
Cost of Construction: $ IF �L
n_
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof B IL Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namelg)"a
Name:
Address: %✓3�7-o cinr2lrcni d -GL /
Company:
City: �fi r,}rvr Stater
Zip Code: (�N9'f I Fax:
Phone No. f77L- 2 ((,-7336
Address:
City: State:_ '
Zip Code: Fax:
Phone No
E-Mail:&iuIJAI-k62 6,zJA-/c.l,
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.
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DESIGNFR ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: (Jaw'Z{-„ I Ld ek
Name:
AddreT�i3Zo 6o..g., •
Address:
City: 5. irru State: Of,
City: State:
Zip: 23- Phone -27�,-1/6 -7388
_
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 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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anif covenants that may restrict or prohibit such
structure. Please consult with Home Owners Association
your 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 FMPROVEBIENTS 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 tTNANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE -OF COMMENCEMENT."———
Sign u o: Ow Ar./, Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STA RIDA STATE OF FLORIDA
COUNTY OF d. t"" a COUNTY OF
The forgoing Instru ent w acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of , 2%IQ by this _ day of . 20_ by
�
ZDa 0ack_
Name of person. king statement. Name of person making statement.
Personally Known --v/_ OR Produced Identification Personally Known OR Produced Identification
_
Type of Identification Type of Identification
Produced Produced
'
;,cn;3tu,e of Notary Public- - o (Sig ture of Notary Public- State of Florida )
• • ;. COH69SSIONSGGI 48
CommissionNOO/14 M.,Dammber17, o fiss ion No. (Seal)
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