HomeMy WebLinkAboutbuilding permit applicationAll APPLICABLE INFO MUST RE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
,COUNTY
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 13331-iMIJ
Property Tax ID #:�� i3 (jam �.; E7 g - -- -- - Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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Ci3NSTRUCTION INFORMATION:
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: Is Utilities: Sewer Septic
Windows/Doors
.X Roof 6 A 12- Pitch
Building Height: __ -- -- - -
OWNER/LESSEE:
CONTRACTOR.:
Name St��eh,� i �n�l�� - --- -_
Name: q it �1�eN0
Address: tilt! `e2:LA A Q&, T
City: pat vn C t1a State: P L
Zip Code: 3 LIqc)U Fax:
Phone No. " O I S a S-- (OVO4
Company: 64 kCk1rfn:(;f
Address: 21iq
City: SiJ,24,T- - State, Ft
Zip Code: 344'14V Fax:
Phone No X t. 8113 3
E -Mail: Irt;~1�G �c Se. fv lion ra LCCt i � �,
— - -
Fill in fee simple Title Holder on next page { if different
from the owner listed above)
E -Mail 6%
State or County LicenseL�'!� i bel
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 LAVH 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 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 Horne Owners Association rules, bylaws or and covenants that may restrict or prohibit ,such
structure. Please consult with your Nome 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 5t. 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
"WAR11MIS TO OWNEW YOUR FAILURE TO RECORD A NOTICE OF COMMEIWEMENT MAY RESULT IN YOUR PAYING
TRICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SIITE BEFORE THE FIRST IiNSPECTION. W YOU INTEND TO OBTAIN FWANCI NG, CONSULT
WIlYll"41MR-LENDER OR AN ATTORNEY BEFORE RECORMG YOURAMOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
/License Holder
STATE OF FLORIDA I STATE OF FLORIDA fA 1112 7r N
COUNTY OF _I�AaniJ _ COUNTY OF - __
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 11 day of . Ll 50 . 20 70 by this_,day cif _ .tel AI/ 20 by
��_w �i �VU_A 1 &, tc"?t P 0
Name of person making statement. Name of person snaking statement
Personally Known k— OR Produced Identification PL _ _ Personally Known X -_ _ OR Produced Identification _ PL
Type of Identification Type of Identification _
Produced tL4AU G#!ACN7l(vt�A Produced rIA1UA F�r� E� .f
of Notary Public- State ol"o - Notary Public State of for ure of Notary
r1 Maria Y Cajachagua
1 No,44 ?3CJ_6d 9 } My Commission GG 93 5e6m Sion No
�i Expires 12/01/2023
My CoYnrnlMion GG 93
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Rev. 1/7/i9