HomeMy WebLinkAboutinguagiato permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 A
PERMIT TYPE: '
PROPOSED 1NPROVEMENT LOCATION:
Address:
a
Property Tax lD #: ?�'_�, "�j�'� - Lot No.
~
Site Plan Name: a a Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Cal ot
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit –check all that apply:
rs
_Mechanical i Gas Tank _ Gas Piping _ Shutters _ Window,s/D�o�oZ__
Electric _ Plumbing _ Sprinklers _ Generator Roof "j� 11 C_ _Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: --T—
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name V
Name: 1
Address:
Company:
Address: 01 o
City: ' ` Stater
Zip Code: Fax:
Phone No. --I Ci
City: Stater
Zip Coder Fax:
Phone No 7M a 3s� – S'L
E -Mail: ,
Fill in fee mple Title Halder on next Page ( if different
from the Owner listed above)
E -Mail I
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
4 "J"aIVCm/r1VU11vr_ttC: — Not Applicable MORTGAGE COMPANY:
Name: Name:
Address:
City: Address:
State: Cit
Zip: Phone y:
Zip: Phone:
_ Not Applicable
ate:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: Not Applicable
Address: Name:
City: Address:
Zip: Phone: City: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
whichsn conflmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
iiict 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 1 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
I --if ,4
Signature of Owner/ Less C ntract7 as Agent for Owner Signature of Contractor%Lt rise Hofder
STATE OF FLORIDA
COUNTY OF,
The for oing instrume . t was acknowled ed before me
this I day of ( 20by
v V,
RiRe of person making ate ent.
Personally Known OR Produced Identification
Type of Identification
Produced
.I�Lure 01-1v0tary Public- State
KATHERINE HAVENS
NIyCOMMISSI i #uG165
Commission No. i ' al) EXPIRES: DEC 04, 2021
Ii �Bonded through 1st State Insur
REVIEWS FRONT ZONING SUPERVISOR
DATE COUNTER REVIEW REVIEW
RECEIVED
DATE
COMPLETED
STATE OF FLORIDA
COUNTY OF 3t_ 1( 1 C' le
The forgoing instrurnent was acknowledgfore me
this day of J IAA' !� .20 v
*k -*RM of PM�o n making stAtement.
Personally Known OR Produced identification
Type of identification
Produced
Public- State of
Commission No.
Li cel
s
PLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW
KATHERINE HAV
Nly COMMISSION #G
I EXPIRES: DEC 04,
londed through 1St State
MANGROVE
REVIEW