HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED {� �\ 2 `�
Date: Permit Number: VU 1 J of
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Building Permit Application o3taa�3a
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 i/
PERMITTYPE:
PROPOSMIMPROVEMENT LOCATIONt
Address:
Property Tax ID #: -`' - hR - �KJ� - �1
Site Plan Name: e
Project Name:
'CONSTRUCTION INFORMATION: , -"
Lot No.�_
Block No.
Additional work to be performed underthis'permit -check all that apply:
ZMechanicai _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
,,/Clectric �Iumbing Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
;OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company:�M���Oc�\
-VI
City: `�c��S ('��sacgc� State
Zip Code: Fax:
Phone No.
Address: a�lO��o51C�.�`�c�����ue\�
City: �`2C. �l \'`CCQ State._!K- _
Zip Code: Fax:�c-�
Phone No `An" - ��� -\ \
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail G GmCs�S�
State or County License��°L11 11 "S1lz)�M
If value of construction is $2500 or more, a RECORDED Notice or commencement is reguirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
'SLIPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION
;
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: zz) Qa
Address:
City: <State
Zip: _ hone —7 r�`5�
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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign t of Owner/ Lessee/Contractor as Agent for Owner
Sig ature of Contractor/License Holder
STATE OF FLORJPA
STATE OF FLOR DA
COUNTY OF
COUNTY OFF �C�2
The forgoing instr,�m�ent was acknowledPP�hefore me
U
The forgoing instrument was acknowledged-4efore me
this�day of Ct.\_ .2d7y y
t
thiiss L5 dayof S�0,\ ` 20,7
Name of person making statement.
Name of person making statement.
Personally Known C,�oR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary
CI -AA,
(Signature of Notary Pu a
Commission No.
.tyr«',, STELLAM HUNTER
'+°: r�`r;`i Notary Pu &eaf ate of Florida
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;''o STELLAII HUNTER
Commission No. .
` ' Notary fate Florida
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REVIEW
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DATE
RECEIVED
DATE
COv.MPLETED
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