HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZJ 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 X
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 2I �W CSA TA" Dv \' "e j
Lot No.
1 4-- r -)M —0i
Property Tax ID #: �!5_3 CCC71—
Site Plan Name:. ML)�Oj)�f Block No.
1.0
Project Name: O'D VC,
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit –check all that apply:
—Mechanical Gas Tank Gas Piping Shutters Windows/Doors
— Electric T Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: q Sq. Ft. of First Floor: -YU
Cost of Construction: $ i J_O ()n Utilities: —Sewer — Septic Building Height: 20
OWNER/LESSEE:
CONTRACTOR:
Name Cr 0
Name: K01,Y)
WIC
Address: 2 V1 VC,
company:
Address: h� 1?) 1 N MuanDY
i V
City: rEv-i- P IT- r 2 State:
Zip Code: z2N<�--L Fax:
City: f&a it V(
i I State:_Ecl
Phone No.
Zip Code: S2
Fax:
E -Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail__QCnkC(61k�±,La
U.NYVI
from the Owner listed above)
State or County License
Q 9 -7
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:
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,,}
TE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YaUR LENDER" W AN ATTORNEY BEFORE RECORDING YOUR NOTICF OF rnmMFNrFMFNT "
Signature of Owner essee/contractor as Agent for owner
Signature of Contractor -ii-icense—H--ofSe'r
STATE OF FLORIDA'
STATE OF FLORIDA'
COUNTY OF 2A
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COUNTY OF
The :fo7ing instrume t was
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Name of 6erson making statement.
Name of person makiingatement.
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Personally KnowOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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IH COMMISSION #GG165030
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Issi 'GO165030
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COMPLETED