HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 61101 Permit Number:
a � s
Planning and Development Services
Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT ` LOCATION:
Address:�'1?' V6 -mV-.
Property Tax ID #: ?hlrce..k 1p • SSa1 "131 -lbw -000 ` Cp
Site Plan Name: 154!�A L Ck.e5- � pVwS.Q I
Project Name:
Lot No..
Block No.
DETAILED DESCRIPTION OF WORK: I
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 _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ k v[ 00 U C7
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER%LESSEE:
CONTRACTOR:
Name w� i�(k�f'1 IXY.�
Name: 5
Company: 1QQV
Address: $ 3a b -.
City: 4. State: F L
Address:
Zip Code: V016(40 Fax:
City: �k Sk . L.yClt. Stater
r �
Phone No. -:, � 0 a kA 1 �J`+l
Zip Code: 3 4C13 Fax: _
Phone No
E -Mail: ry 1 LYNl
Fill in fee simple TitlJ Holder on next page ( if different
E -Mail Ke Xk CK-r)CAurY-N\r-a!ReW%A0,1
from the Owner listed above)
State or County 4censle ripe %L42' -6'6.-)b CO
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 LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
UWIVtK/ CUNTRACTOR 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 YCY►R NnTICF nF rnMMFINrFMFNT 71
Sig ture of, ner/ ssee/Contractor as Agent for Owner
Si ature ontract /License Holder
STATE O FLORIDA
STATE OF FLOR A
COUNTY OF � . �,���
COUNTY OF �� LULa
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 12 day of �AQNJ 120).6 by
this _k L day of MPO , 2016by
1n 'ISi�a K_WN^6 cls
h 5ba t=WiLkS
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification F5& ��i 'f°
_VdAifAS
Type of Identification
Produced 1AC0poducediv
— e,pG64401@8ds�d�
•
(Signature of Notary Pu c- State f Florid9)* L ;
f ? • G
S Lure of Notary P blic- State of Fldi�ida,};
Commission No. S Se Oma• fe��'G92
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- Coriimission No.
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE _ `'I'1ANCa�#�VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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