HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: + 11 -- 0 Permit Number:
3 7 3 ..
Building Permit Application
z 57/
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
PERMIT TYPE: Delnoh f ,fln
PI;CtPUSED IMPROVEMENT LOCATION•
Address: I D % SI S 0_,e.4n 9,,-%I/z'I JI4Se,' Y"-1 h , /7Z • J y.7'3 /
Property Tax ID #: g5111 -,3// -QQl `z - 000- / Lot No. lz
Site Plan Name: V C'� / &)r, 0'' 0
Project Name: IY12
G4J /�Di��a Y'A4m ditG/ C�i�`yewV
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Block No.
Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _
Plumbing
_ Sprinklers _ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
/7,20
Sq. Ft. of First Floor:
/72
Cost of Construction: $
...200• ve
Utilities: Sewer _ Septic
Building Height: 8A/
N a m e /".Fc k q -6% C, d' &i-f li,41t Al. : tZ i VY)
Address: .2d y,F 4r4 tAih LAl.
City: Fort Layalerda•/t State:lpL-
Zip Code: 333I 2- IF
Phone No. 9pl-zU / - 91S7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 17'117 /-7J Tir y�
Company: 4r» �i�i/h JOACar f _Jrye• %,7c•
Address: e4Ge-
City: Te /J fe h9&e GA State: /y
Zip Code: 31175 1 Fax: %%P-Z31- 2%71
Phone No 7-72- 6O --37/5-
E-Mai1 4 CiH+ sM' 71-A /JC CV Y4llea• COM
State or County License (f'oc/.2 -T iqy
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 EN EER: _ Not Applicable MORTGAGE COMPANY: _ Not le
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not ate,
DING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: one: Zip: Phone:
OWE -RI 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 LEND OR AN ATTORNE ORE RECORDING YOUR NOT COMMENCEMEN "
Rev.
Signature o caner/ Less Contractor as Agent for Owner
Signat re o Contractor/Lic o der
STATE OF FLOAIDA
STATE OF FLQ�IDA
Y (GLr +1 ►'1
COUNTY OF y �-� �
COUNTY OF
The for oing instru ent was acknowledged before me
for
The for oing instru ent as acknowledged before me
I �hday 2�D by
this of �� 2� by
this of ,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
�
Type of Identification II
Type of Ide tificatio�j
Produced�(G
Produced
r'�
4((SignatuVreNotary
(Signatur f Notary Public- State of o4c9Riei��) MARYLEEMATTIS
Public- State ooIq ,�dnrd�a) M�,RYLEE MA7TIS
e � . ,., c COMMISSON#Gq•.COMMISSION
Commission N'�"40)wyEXPIRES: March6,20Commission
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No.N'l �ea�p�ES:March 6,2021
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DATE
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COMPLETED