HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
IF
R I
COU NT Y
F t o rz i o ri -
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: GAS
Address: w .
Property Tax ID #: I ��
Site Plan Name:T��,�'�fC,'
Project Name: dJF-Pjr jG`
OETA,MED DESCRIPTION OF WIDAR
CONSTRUCTION INFORMATION.
Permit Number:
Building Permit Application
Commercial
�.? 7 - UWU
I F
Additional work to be pe7(G;as
ed under this perm.t - check all that apply:
—Mechanical Tank las Piping Shutters
— Electric — Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
- Sq. Ft. of First Floor: _
Cost of Construction: $ 44. q _ CW ` Utilities: — Sewer — Septic
City f State.
Zip Code: Z!f Fax:
Phone No. f- • O
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:_]
Company:,
Residential
Lot No.
Block No.
AGE -PLAN
_ Windows/Doors
— Roof Pitch
Building Height:
cit: C State: F4__
Zip Code: 40 Fax:
Phone No -� (�-'� •
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.
=°Ar O�&e�F Notary Public State of Florida
Charmin D Walker
_. n GG 225827
StJPFii~Pf'ACON
`"p"RU
CTI ORQEtN'TAW iNFOR MATiQN:
DESIGNER/ENGINEER: _ Not Applicable
Name: MORTGAGE COMPANY: _ Not Applicable
Address: Name:
City: Address:
State:
Zip: Phan City: State:
Zip: ^ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: i _fyat Applicable
Name:
Address: Name:
City: Address:
Zip: Phone: City:
Zip: . Phone:
OWNER/o the wo
CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to drk 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
"WARNIING TO OWNER: YOUR FAILURE TO RECORD A P*OTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYIING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IN
IF YOU TEND TO OBTAIN FINANCIING,
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
WITH
Signatu f Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF I M
amd-)
The or, oing instrument as arq owled eg_d before me
thiday of 2' by
50�
Name o erson making /atement
PerspmMly Known " OR Produced Identificatiow-
T e of Ictentifiragrin
LN
(Signature of Notary Public- Staie of Florida )
Commission No. W00Notary�3ltkeeorf Flonda
C;nR,1, a
My Commissicn GG 22827
--- G � S REVir:%Ai
REVIEWS FRO
IUPERVISOR
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
alai latute ar-Lontractor/License Holder
STATE OF FLORIDA
COUNTY OF wm—�
The r oing instrumen as ackn wledgpad before me
VL
day of 26by
(C
Name of person making statement. /
Personally Known ✓OR Produced Identification t/
Type 4f-0eni ,ation
(Signature of Natary Public-
;�nmission No.
If
PLANS I VEGET
REVIEW RFV11
f
ate of Florida)
a Notary Public Staten' Flonda
� Charmin D `)Valker
POesEV
06106120 2
1Q REVIEW