HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE pIN�FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� �I
Date: ol- i%a Cam(./ Permit Number, — v I
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578,
PERMITTYPE:
Address: J �'] d.7 11, ft6 0
Property Tax ID k'Pfa ' 60a "
Site Plan Name:
Project Name:
RECENED
At111
�JAN.081010
Building Permit Applicattion Department
St. Lucie rn,,,,,,,
Commercial Residential
Lot No.
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 Constructit�i: J9 X
Cost of Construction: $ '�/ 000
Sq. Ft. of First Floor:
Utilities: -Sewer _Septic
Building Height:
0
OWNER/LESSEE:
CONTRACTOR:
Name eac IF C an
Name: Y
Address:
I
-Company:- t�L- . ',. I,
,!Address: D pb C!
City: Stater
Zip Code:3 ax:
Phone No. .tea.
City: SOH , r};. ' !I State:
:ZipCodet`
J' yb-1 rl- Fax:
Phone No
E-Mail:
'g
Fill in fee simple Title Holder on next 04e (if different '
from the Owner listed above)
E-Mail
State or County License
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.
SUPPLE
ENTAL CONSTRUCTION LIEN LAW
NFORMATION;
DESIGN
Name:
/ENG NEER:
_ Not Applicable
Y
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip:
Phone
S te: CG
City: State:
Zip: Phone:'
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 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
Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF I COUNTY OF
The forgoing instrument vyas acknowledged-b@fore me The forgoing instrument was acknowledged before me
this day of 7(AnJ 20 PP -by I this day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of identification
Produced J)L.. F 4—
of Notary
Commission No.
REVIEWS
COMPLETED
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public -State of Florida )
Commission No. (Seal)
.wur z[, 2022
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