HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
S J
•
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential X
PERMIT TYPE:
9 PQ6JI IM. FKK M NI L KLN, II _
Address: U01D l SAI.e-2 o 4d +4. P, -F� � L.
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: t)L4Mkik. tiaais.AcdaiL UnQkL'%0 LQZ/A)-�e,,C le :cY
I DETAILED DESCRIPTION OF WORK: 1
CONSTRUCTION INFORMATION:
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:
Cost of Construction: $ %66 Utilities: —Sewer _Septic Building Height:
Name I
Address
City: t'
State:
Zip Code:Fax:
Phone No. 4 (�
E-Mail:``Otyql�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company:
City:
Zip Code: )9 9S3 Fax:
Phone No `nr -S2_1— 1+92-S
E-Mail U C4A1 'C,/ C
State or County License CC-] DoIE�SVA
f value of construction is 52500 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.
+L
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
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
yWTy YOUR I ENKR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF,- pMMENCEMENT."
SYgnaturk-6f Owner/ Lessee/ ontractor as Agent for Owner
Signature o tractor/License Holder
STATE OF FL IDA \
STATE OF FLO� DnA�, 11'
COUNTY OFF �Y"i') a
COUNTY OF I V Y�Y t I
The fpcgoing inst ument was acknowledg d before me
day )�1� 20Zby
The f oing instrument was acknowlecl d before me
J�by
this) of,
Vy*n r) ! in' I"
this2rdayof�)I�jA
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Name of person making statement.
Name of person making statement.
, %
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Ty a of Identl icati
Type Identification
P uced fs�of
Produced L
. y. • "", LESLI
C WARREN
ign ure of Notary Pu lic- State of Flori Commissi
n RiSNIB o otary Public- State o Florida )
My Comm.
ires Sep 19, 2023
Commission No. "1.1 L-11.7.( aI) Bonded through N
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ti�jjf�i%W 'i _ r��F,�IEC WARREN
"Notlty'p061ic - State of Florida
y Commission 0 GG 243626
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National Notary Assn.
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