HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMrLETED FOR APPLICATION TO BE ACCEPTw
Date: 5`a-11T—
Permit Number: 3 aC5s'��o3�
Building Permit
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
PERMIT TYPE: L
Address:
Site Plan Name:
Project Name:
(eQ -4- 4y Pe-e4-
MAY 2 9 2020
Applicat) . Lucie County, Permitting
Additional work to be performed under this permit -check all that apply:
_Mechanical
_ Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ q SLo • CD
_ Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Residential_
Utilities: —Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
F xa »..re'G f' s��Ri 1 -c 7`' i t 7 i t�
+r t' 4^4a
CONTRACTOR
Name on
Name:
Address: Ek
Company:.
City: �� • 1e(C•C State:,.. ,
Zip Code: 3Ci-182k Fax:
Phone No. 11J3L-475-31C)q 7rlg -aOi - D$3y
Address:'"
City: State:_
Zip Code:. Fax:
Phone No
E-Mail: [1CtCol 10I T (P QOI • COn'-%.,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
�SUPPIEMENTAL CONSTRl14CTiQNLIENLAUU,INFOf�MAT10N
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 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."
4_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature Of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk . Lo
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �_ day of T+ e.24 20_1,o by
this _ day of . 20_ by
Q3a. "a A"\\1O.r\
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced t... b L
Produced
(Signature of Notary blic-State of Flor'
(Signature of Notary Public -State of Florida )
Commission NO.6 9' �"". GEEAyN-N I)NIi1GG022s023
Mycq so
Commission No. (Seal)
rt'� yar1B 2020
EXPIReS,
Unde'WAWit
old
REVIEWS FR ZONING SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.