HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLY , cJ FOR APPLICATION TO BE ACCEPTED
Date: a31 e, RECEIM Permit Number: 200 3 -o529
MAR T,9 2020
Permitting Department
6tifff ffit`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: & / M9 &- am
PROPOSED IMPROVEMENT LOCATION:
Address: JJiD 111113WGfYL}UUUU
Property Tax ID #: 3 IO3 -!5 -(,W3` OQO- Lot No.
Site Plan Name: Block No.
Project Name: ffildwav CJf'P1
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: ,71
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
✓Electric ✓lumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Z5 occ�� Utilities: —Sewer _Septic
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
..
Name mso avma
Name:
Address: �56 r fflljfwa
Company:
f77MF
City: R bam L State• _
Zip Code` 7 9qFax:
Phone No.
Address: l 7
h p ef— ffomv
City: . ere State*
Zip Code:Y Q 5 Fax:
Phone No 7V- X _5 02�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
rGCIV va
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.
V BCD
SUPPLEMENTAL CO
YCTIV11EN LAW INFORMATION:'
N
Not Appncanle I MORTGAGE COMPANY:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City: City
Zip: Phone: Zip:
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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contra for/License Holder
STATE OF FLORIDA
STATE OF FLORIDA t
COUNTY OF Z7 LAG
COUNTY OF e
C
The fo+going instrument was acknowledged before me
V1
The forgoing instrument was acknowledged before me
this day of I c r �1.. 20�Oby
this day of / 20_2:9 by
1t�[^1
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
� D l�
Produced
D l �l
(Signature of NotatY Public -State of Florida)
(Signature of NotarV Public -State of Florida )
Commission No. C7G 11-27 7-1 (Seal)
Commission No. C22 77 <� (Seal)
REVIEWS
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Colleen
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Sue Hayes �
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PLANS
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It9IEW
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19