HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater Permit Number: IA®S'—
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:
`PROPQSED lMPROVEME�fT LOCRTiON S JF JY k� y 1� 43 h L R� Sn P
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Address:
Address: C-4,
Property Tax ID#: _ L/ �® — �(� °— ®�I (`YDQJ • Lot No._2_0cl
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ � �� 00 Utilities: _Sewer _Septic Building Height:
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Name t-, Name: T.A Le-Vu`I S
Address: ,�c� e� �n,J Com an
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City: c�- p)P rr�=, State: Address: '781
Zip Code:
L Fax: City: "'12 60 &a J State:/
Phone No. "- ��f{- «J Zip Code: �c^I Fax• ��--�7(vl`�I 77.5
E-Mail: Phone No '-7Z 3 6
Fill In fee simple Title Holder on next page(if different E-Mail .i C "t"I G`I LlC i Cc ii7
from the Owner listed above) State or County License '6e,
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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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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 County makes n64epresentation 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."
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Signature of Owner/Lessee/Cont actor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ` STATE OF FLORIDA
COUNTY OF COUNTY OF Sr Lx e-1 The forgoing instrum rit was acknowledged before me The forgoing instrument was acknowledged efore me
this day of V .20 y this day of �M 0,LM 20 2.. by
Tat
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 JJ
Produced_- L L Produced 4—L
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Fildricla}
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.