HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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 Number:
Commercial Residential ), �c
PERMIT TYPE:
PROPQSEp INfPROVEMENT,lQCATlON
Address:
Property Tax ID #:- ? /> _ u� "� ' "� �� '' Lot No.
Site Plan Name: ? ' 8dam'., L%d'w 6 �!/;) b Block No.
Project Name: > v n ,u nd c', w 1 f •, _& 11 A
CONSTRI�CT10N LNFORMATION t
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s
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 6 Pitch
Total Sq. Ft of Construction: cl6) - Sq. Ft. of First Floor:. A-
r: 1! `>d
Cost of Construction: $ % � 3 0 0 � Utilities: —Sewer �! Septic Building Height:
0111/NER/LESSEE Y ,
r
C(3NTRATOR. ,' t
Name 1` 1 L
Name: G I c v\ e d °° .1 I
Address: J I—) f�jp,, 4�`f,,: _ !
' snei. 6 �, � (� d
!Company: I_tv
City: QLr;k�w ;, State: _
Address: ^ r ,.'__ 'S ��n r R !} d J I� '
Zip Code: � � f;� 71 6'6, Fax: 17,1, / - E .S55
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City: �_Juc� : State:' FL
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Phone No. . %��:;� ;r:' l
Zip Code:'�,._14 Ct/ Fax:'%
Phone No ' 7
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E-Mail: t nt r4?.i�„a�'7TC €ij
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License el,30_ 1d-111-1 l ,-1 k
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.
.UPP,MEITAI,:CNSTRICTtiIIN;LAo1I!_ FP+TION:
,.......
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE FOLDER:
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 Count 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordine vour Notice of Commencement._
Signatu o f Owner/ Lessee/Contractor as Agent for Owner
Sign ure of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ` {- i _o r t e
COUNTY OF S± L,-. o c_
The forgoing instrument was acknowledged before me
The forgoing instrument was, acknowledged before me
this/' .day of� 20 �)by
this I`7'_day af� ,,20 Irby
Name of person making statement
Name of person making statement
Personally Known i,,�/� OR Produced Identification
Personally Known OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
`
ILI
(Signa re of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida 1
Commission No. e°�parp�e�,n " AA�S,(towE
— ommissi n �(G 104656
Commission No. o't'R;„lj", (S NDASROWE
* *
N91 moo` Expires May 19, 2021
* * Commission # GG 104656
w Expires May 19, 2021
F Bonded Thm Budgot Notary Sorvkas
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Rev. 812117