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HomeMy WebLinkAboutBuildng permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: PROPOSED IMPROVEMENT LOCATION: Address: r Permit Number: Building Permit Application r" Commercial Residential y -``f it Property Tax ID #:: y, 3 Z Q Lot No. l(�p Site Plan Name: f�'Ir, rlrj �r ( t I ��- r e Block No. Project Name: f DETAILED DESCRIPTION OF WORK: �n emce , CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers_ enerator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ �(, „%�?�, �r Utilities: _/Sewer _ Septic Building Height: OWNERAESSEE: CONTRACTOR: Name Q� Name: Address 7 30 n Company: �; e � City: State: Address: /_ 0 (dC" Zip Code:_3 qq g Fax: City:. V(- r0 8 Stater Phone No. "` oi- Zip Code: 3a4(o0 Fax: _ E -Mail: Phone No -1-1 ct 0 Q3 (CIS Fill in fee simple Title Holder on next page ( if different E -Mail �� 1(,ii q®l @1 C1 p`. cpn) from the Owner listed above) State or County License ,(n� ©( 1 n If value of cons ion i5 5 n N Lary t �a 04DED Notice of Commencement is r qu�� Notary Punic state ai/lofrda If value of H11 fa , �O�;;r &IM JWD Notice of Commencement is require . a° ' CharrtNn 0 wars AMY conwym � 04 Comrmss�on GG Qr��o Expires 06106W32 MY Expires 06!061207! COUNTY F L 0 !i r D A Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: PROPOSED IMPROVEMENT LOCATION: Address: r Permit Number: Building Permit Application r" Commercial Residential y -``f it Property Tax ID #:: y, 3 Z Q Lot No. l(�p Site Plan Name: f�'Ir, rlrj �r ( t I ��- r e Block No. Project Name: f DETAILED DESCRIPTION OF WORK: �n emce , CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers_ enerator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ �(, „%�?�, �r Utilities: _/Sewer _ Septic Building Height: OWNERAESSEE: CONTRACTOR: Name Q� Name: Address 7 30 n Company: �; e � City: State: Address: /_ 0 (dC" Zip Code:_3 qq g Fax: City:. V(- r0 8 Stater Phone No. "` oi- Zip Code: 3a4(o0 Fax: _ E -Mail: Phone No -1-1 ct 0 Q3 (CIS Fill in fee simple Title Holder on next page ( if different E -Mail �� 1(,ii q®l @1 C1 p`. cpn) from the Owner listed above) State or County License ,(n� ©( 1 n If value of cons ion i5 5 n N Lary t �a 04DED Notice of Commencement is r qu�� Notary Punic state ai/lofrda If value of H11 fa , �O�;;r &IM JWD Notice of Commencement is require . a° ' CharrtNn 0 wars AMY conwym � 04 Comrmss�on GG Qr��o Expires 06106W32 MY Expires 06!061207! SUPPLEMENTAL CONSTRI it DESIGNEONGINEER: - -NotApplicable— Name• Address: City: - zip: State: Phone FTE SIMPLE TITLE HOLDER: �,_ Nit Name: pplicable Address: City:_ Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: — . � Phon BONDING COMPANY: Not Applicable Name: Address: Clty: "R- —. Phone_ OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a rmit I certify that no work or installation has commenced prior to the issuance of a perms to do the work and installation as indicated. St. Lucie County makes no representation that is granting a hermit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules structure. Please consult with your home Owners Association and review our deed for an restrictions which may apply. bylaws or an covenants that may restrict or prohibit such 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 COM TWICE FOR IN PROVEMEIIITS TO YOUR PROPERTY. A NOTICE OF CO yENT DUST Ii3E RECORDED AlENT ESUL IN OUR Wc POSTED ON THE J013 SITE BEFORE THE FIRST INSPECTION. I F YOU INTEND WITH YOUR LENDER OR AN ATT RNEY OBEFORE REiCORDiNG YOUR IIfOT�E OF CQ OBTAIN ANClNG, CONSULT IENT." - --- - -• --v 1-a4c t ontractor as Agent for owner STATE OF FLORIDA COUNTY OF Ci`� • The far oing instrume was a nowledged before me this, day of _ 20 Zo by Name of person making statement. Personown `AOR Produced Identification I TYP f Iden 'ficatid, Je 0019na�tgre of Notary Pta) State of Florida ) 6G mission No. _72 S g- (Seal) REVIE=6Clker2582;11 1 DATE DA ke O Signature c'(�,6'ntractor/License Holder STATE OF FLORIDA COUNTY __AAVS-_� -The f r oing instrument s a=120_?Cby edged before me this day of Name of person making tatement. Personally KnownOR Produced identification Type of Identification it Lti Cct�_ of Notary Public- Stat Florida ) G4S No. (Seal) RVISOR I PLANS VEGETATI Wp. q t . N It l- - - 1 REVfEW REVIEW ° a' -- — iEVi miss; G EW