HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: tc 1 ` I a� 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
PERMIT TYPE: ti -' � FI r. j �' 1 � 1-, �
PROPOSED IMPROVEMENT LOCATION:
Address: 1))(00
Property Tax ID #: ��J`1 - �� �^ �� -� �"� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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: $ o �� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ii>StAo Name: 3(3,f CAS t✓ C'-
Address: Company: "oALOO-
City: State: Address: "0
Zip Code: )�AQ\5 ` Fax: City:y-'r-Tl e'RCE State:
�J `)9- Scl Zip Code: Fax: �A U \"'A Lp?,,S
Phone No.
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail -aHme"''(` o0.VL " 0.0\ C11�,, u�1
from the Owner listed above) State or County License aC- 2M V-c 3
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to oo the worK and rnstaiiauun as niuii_aLcu.
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
., . r.,-1 M . Awr wTrnnwtry nrrnnc DrrnRnlNr. YnuR NOTICE OF COMMENCEMENT."
��Iln �vvtt �u�uuc v.. M. ram■ .v...�. ---
-- -- - ---- --- - --
Signature.of Owner/ Lessee/Contractor as Agent for Owner
Signgt e of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF tC1 c
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of �uYl2_ , 20_ by
this � day of --�0,r1L 20 aU by
Name of person making stateKent.
ent.
Name of person mak77Produced
Personally Known OR Produced Identification
Personally Known Identification
Type of Identification
Type of Identification
Produced
Produced
j)ja��� Ft ?c� �
eL
(Signature f Notary Public- State of FI rida)
(Signature(6f Notary Public- State of Flo ida )
Commission No. Q9D l MC) �eaWtary Public state or Flo
ict!om ission Now !i4cl ib Notary Public State
Margaret E Montepar
iQ,Ok*a1)
Margaret E Monte
My Commission GG 214
90 � My Commiss on GG
pip
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REVIEWS
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COUNTER
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DATE
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Rev. 1///19