HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a ro d Permit Number: -. O03 -Oro 5S
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: d�
Address:
S
MAR 2 5 ' 720
Building Permit Applicati �oun
- / h', Permttbng
Commercial V Residential
SPG
S�.
Property Tax ID#: ��\� —SOt ^���`` �Z�-\ Lot No.
Site Plan NameTeF�}C ce:;' L�J� C \r\rex \ ���R ` Block No.
ProjectName' JC:,C-Q-L-'Z1. l �C�C1��c'��> �Z2Q\A.C--=i� ec� Sc-
Additional work to be performed under this permit -check all that apply:
_Mechanical //GasTarik' _Gas'Piping _Shutters _'Windows/Doors
Electric 'v4umbing' - _Sprinklers _Generator Roof Pitch
TotaPSq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ {. S �� Utilities: —Sewer _Septic Building Height:
Name!�� A-� '�ys\d � el? Name:
Address:'�'Sa�i S-�1 S'Nr - ,\ 4; u ' \0"Z Company: .s r
city:RS� State '
Zip Code:77`\CtS 5L F.&I-IACATISr -O%-;t%-k
Phone NoQ 1-j?) %lr\%- SS \3
E-Mailc� Soa.:.sh\0.`CaS .COf�{
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
City: z%�r��%<_ �r[t�' State:
Zip Code: OZ i`7« Fax:
Phone No 7-zz'' '25 3
E-Mail
State o ounty License g - 4 5-4 Si
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 f 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."
Signature of Owner/MYTCETContractor as Agent for Owner
gnatu a of Contra or License Holder
STATE OF FLORIDA
�.�.�1 C.�'Q
STATE OF FLORIDA
COUNTY OF
COUNTY OF ST.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this�ly_ day of 07 0il2C N , 20_0 by
this I(f day of ICI FFieaH , 20,;D by
6Rgrh &It 1 cK dF14 b" S
Name of person makings tement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification JL
Type of Identification
Type of Identification
Produced
Prrood\)uced. LcL!�s&C49_
ko() nto ( .Cit/riv� /V
,RtyeAS
D
r�)G�� W`= _�/S' .fG •' ', .
(Signature of NotVy Public -State of Florida )
(Signature off -Not Public- State of Florida)
Commission No. DOROTHyBASKIN
GG 030145
Commission No. .'."�°�a7•. DOROTHYP(fg�gKIN
COMMIS
;,i :,2 MY COMMISSION#GG 030145
EXPIRES:Octoher2,2020
t:i< EXPIRES: OCIober2 9090
'•,9
onset Tim Notary Public I
Inderynitm
REVIEWS
ING
SUPERVISOR
PLANS .
VEG
VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.