HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit PermitNumbera t�i-a'bL�'�S
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
Building Permit Application
F c7R 19 '020
Commercial
PERMITTYPE:
4.
PROPOSED IMPROVEMENT LOCATION:
Address: %9cZ Legrtg Cmy t
Property Tax lD #: 3321 ��3 " er)d ' C:bO—a Lot No.
Site Plan Name: tA3:1 k-y smA Block No.
Project Name:
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 ` ' Pitch
Total Sq. Ft of Construction: 26 V Sq. Ft. of First Floor:
t
Cost of Construction: $ Utilities: _Sewer _Septic Building Height: �G
OWNER/LESSEE:
CONTRACTOR:
Name ca✓i
Name:
/�
Addres,s�:_%//$OZ. ZOete. (2wcl a t,.J�d +�1
—7-
Company: C� L1 d— 4e ,
City: �/J/lf - ST Lue�l State. Pr
Zip Code:-??g552— Fax:
Phone No.
Address: e
City: OG Pj%e4,e—,eState:_
Zip Code: 34{56z Fax:
Phone No 7_ Z ^ 708 "
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail �JGbeatrd tt (i t� 9�7 bA
State or County License z/�3(et .
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.
S PPLEMEN L CO STRll).C-i
DESIGNER/E IGINEER:
Name: s
T&ONIMENUMIRTON:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: 37g!/ Phone 6r07-73V,.1
State:
97CP
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 commented 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 gW.fok JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WlTH4WRJ&NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
�y
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF gar. L�eti�
COUNTY OF Sit , lJesy
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this%N dayof F`b ,20a.a by
this-ndayof 'qa16 ,2A14 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific Lion
Type of Identification
Produced t'
Produced
(Signature of Nota ublic-State of Florida)
(Signature of N
.ta- �c_FVENS
�NEPS
�pMARIE 02202a
?
oi."n:;rig�., Dpgry r
COMMISBIOyBGG 022029
Commission No. O 11, ,pGG
M�SSe�n 62020
Commission No
i'�
IRES:Dece.S6 2020
MY pbef"Oli UndeNm`3°'
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Rev. 2/7/19 1 1 - /