HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
AP
COUNTY
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
PERMITTYPF:
Address:
Property Tax ID #
Site Plan Name:
Project Name: _
PROVEMENT LOCATION:
3y��1 - (0 (5 )'c I _000 -0
DETAILED DESCRIPTION OF WORK:
r S i -c,, ll ('\ e- 'J L4_p t,l L C- i -r- : C. W ( '" ecLkt A
Lot No. 1 a
Block No. I
CONSTRUCTION INFORMATION: -
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric ZPlumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
q so . oo
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name C lC �► ` 9� : 1��
Address: Kv a w :I I ousS R -,_Z
City: 0 ; . Co T , k C : State: V'L
Zip Code: 3'{ S r'Z Fax:
Phone No.
E -Mail: -_
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:r,n r�A err.' S
Company: -ce L P 1 Jn-b: mac;
Address: 41 Ii
City: 1�r-, frLe State: F—C
Zip Code: 3 1,lrl k a- Fax:
Phone No -1 -1 - 7 '�C, 3
E -Mail r--QA,P1��r-h:"j 12L4A-r^�-1. iyN
State or County License Crc- 1q9-9 34
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
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 thepermit 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU O` ICE OF COMM CEMENT."
i
Signature of wn / Lessee/Contractor as Agent for Owner
signature ofntracto /License Holder
/yaSTATE
0(LORIDA
STATE OF FLORIDA
COUNTY OF --r
COUNTY OF �i (� r\
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of -rg_ 20'L)by
this,V-- day of -yJv4— 20 Zv by
in. C_(-4 I-e.��: S
Name of person making statement.
Name of person aking statement.
Personally Known VgsOR Produced Identification
Personally Known V/OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
igna ure of Notary Public- State of Florida )
n ture of Notary Public- State of Florida)
Commission No. 0Notary Pun(�S�AAp 7 Fes+
Lee Hite
Commission No. .rte Nota State of Fronde
erri
L My Commission GG 387402
Kem Lee Hite
My Commission GG 387402
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REVIEWS F k6le^ov S RVISOR
PLANS VEGETATION L R V
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. �� Notary Public to Of
Kerri Lee Hite
My Commission GG 387402
}or t+/ Expires 08/1912023