HomeMy WebLinkAboutBuilding Permit Application ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: 00r-
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:
■#,ROPrOSED6MPRO,uEM;ENITTLOCJ\TION'
Address:
Property Tax ID#: 7� s�D`� �V b`T oC��/j Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION CSE WORK:
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Tom' �z C)f®
C�ONS�TRUCTIOIV IN'FO♦RMaTION: F.
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shuttersindows/Doors
_Electric Plumbing _Sprinklers _Generator Zoof Q�= `Pitch�4`
Total- of Co n- I 4r'structio �"0 GgV , Sq. Ft. of First Floor: �
q tF
Cost of-Cons ruction:$_-' , 00-0 Utilities: —Sewer —Septic Building Height:
0 NER/LE-�SSEE: C.O,N�RAC«ii'tO.R:
Name ��� �0�-(N - — c'�f"� i� Name: p'I( -I.-vi
Address: &%tKj,, V.WbT, %,` Company:�%Q(N W
City: 1�`� (l�� c� State-C-k_ Address: 1.52 0i
Zip Code: Fax: City: M 11-1AAA _ State
Phone No. gi� Zip Code: Fax:
E-Mail: �3: �o .� �i l��� ( V` Phone No TIZt lo,6A,
Fill in fee simple Title Holde' r_bn,:next page(if different E-Mail
from the Owner listed above) State or County License_C' 6- C 0 - B 7->2-W
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required ��Q�
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. IJ
SUPPLEMENTAL CONSTR+UCTION LIEN LA4N INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: 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)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 RESUL IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YO R PROPERTY. A NOTICE OF COMMENCEMENT MUST/BIE RECORDED AND
F/ B
POSTED ON THSITE FORPTHE FIRST INSPECTION. IF YOU INTEND TO OB AIN/FI ANCING, CONSULT
WITH YOUR L ND ORA O NEY BEFORE RECORDING YOUR � OF CO M N M NT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �-� STATE OF FLORIDA
COUNTY OF L«c — COUNTY OF t .I
The forgoing instrurrIent was acknowledged efore me The forgoing instrument was acknowledged before me
this�day of 20� y this�day of / ) 20_C:)y
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification ! Personally Known OR Produced,Identification
Type of Identificatio,�_ Type of Identificatio �7
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of'Notary Public-State of Florida)
Commis o o`�iP�y Fi , ��, ,AUG Co rnjseip (Seal)
IN_State of Florida-
Notary ,o1r Pim
_. ;_ ., E
Commi Y Public =State LEEN V4
—
Stat
.` Y Comm SSion E IUU79 :9�0,P, .` ommfssio a- °tart P
REVI tobe_�� �res UPERVISOR "'" VELv sio 'Ck `f MANGROVE
COUNT REVIEW REVIE bar 22 20 REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19