HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 IS-?_02AD Permit Number:
—-------- -- 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:
PROPOSED IMPROVEMENT LOCATION:
Address:9gH '?)aid a4pre.25' *-Q\
Property Tax ID#: ILiIg-I:aQ•0CL4CI-b( 2' Lot No.
Site Plan Name:
Block No.
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: Q IQL4
Cost of Construction:$ 3q
&RO OC
Utilities: _Sewer _Septic
Building Height:Y
Name so -y -a w iysc)n
Address: Liq C` ,I j0( ,S5 dLkl
city: state:
Zip Code: ,3gLj,—i I Fax:
Phone
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: dQ. A S I IVP r
Company: 1-1 L I i CO n
Address: I (10:; KV - c if 04--h
City: (I nA JQQ State:
Zip Code: .3aU I Fax: S/.�.SUy flys I
Phone No S(3 5fe'7-I0CQJ
E -M a i l IOe-rw i 'fa- {'lit I; cjp nj S a, 0_0 m
State or County License CSC Ia'. F:5"i ( L-)
f 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.
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con, 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."
Sign u of Owner/ Lessee/Contractor as Agent for Owner
Sigpdture ofTontractor/License Holder
DESIGNER/ENGIN`E�E�R: _
Name: Ali oci r r ���(J=
Not Applicable
MORTGAGE COMPANY:
Name:
/Not Applicable
Address: `7`I30t-I rJ F to i
_
M'Lo
Address:
this-Adayof 20Wby
City: T( A -A0.
Zip: '.3;31LO; API Phonei)�M
State: _
13g3
City:
Zip: Phone:
State: v
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
- of Applicable
Address:
,
ProducedN.
Address:
City:
`
City:
Zip: Phone:_
(Signature of Notary Public -State of FI.'ida,{`"
Zip: Phone:
Commission No. ACi02E1816
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con, 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."
Sign u of Owner/ Lessee/Contractor as Agent for Owner
Sigpdture ofTontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Oi U-A)hY1oL,lL1 h
COUNTY OF+VkWl - m- Ot ih
The f r oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisdayofi�(%202Dby
this-Adayof 20Wby
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Name of person rhaking statement.
Name of pe son making statement.
Personally Known _ OR Produced Identification
Personally Known 2C., OR Produced Identification
Type of Identification
Type of Identification
Produced
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Commission No. ACi02E1816
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