HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE FO MUST BE C( LETED FOR APPLICATION TO BE ACCEPT
Date: c.6J Permit Number: o d LJ �1�19 l✓
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
M
Building Permit Applicati n
Commercial Residential
I PROPOSED IMPROVEMENT LOCATION: I
Address:
M
Property Tax ID #: 3 3 z 3 " '�T%® Lot No.
Site Plan Name:
Project Name:
Is7:1r-11IRA91101:6Yy:1
1619
L `e
Block No.
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit— check all that apply:
_Mechanical
_ Electric
_ Gas Tank
Plumbing
_ Gas Piping
_ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 'k / 3 00 D . d p
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
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Name:
J" C(C— i
[45
Address: f
' 1 _ -
Company: Mr&L Q,(c� tgad�g�,
City: G7 r
Zip Code: Fax:
Phone No. luffz dv2-0
�State.
Address; qq NW +10'endq j_4ne
City: Ps c, State: IC —
Zip Code: 3499(49 Fax:
Phone No 21a� 3
E-Mail: % T� � 1
Fill in fee simple Title Holder on next page ( if i i erent
from the Owner listed above)
E-Mail s ` N-TI2ad
L Co
State or County License C-3G
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 CONSTR(ON 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:
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
w vni in E runro no Au ATTnoury Rccnoc ocrnornur vrn in unncc nc rnwwcurcM1ruT "
Signature of Owner/ Le / ontractor as Agent for Owner
Signatul a of ntractor i ns Hol ler
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF l'
COUNTY OF
The going instrument wall;acknowledged before me
The f going instrument w s acknowledged before me
this day of �r�20�) )by
thisy day of Warn lip, 202Q by
!-)ILLS
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identifi{at+en
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Type of Identificaplen
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Produced Y —
Produced
(Signature of Notary Pu c- State of Florida)
(Signature
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,.:State of Florida -Notary Public
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Commis
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DATE
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