HomeMy WebLinkAboutBUILDING PERMITAll 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 TYPE:
I PROPOSED IMPROVEMENT LOCATIOf
Address: — , V,
Permit Number:
Building Permit Application
Commercial Residential
Property Tax ID #: aN 30 . 50 _ 00 - 000 " U Lot No. 1-4- a ��
Site Plan Name:Block No.
Project Name:
�k, C3ESCRIPTION OF WORK;
CONSTRUCTION INFORMATION:
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:
Cost of Construction: $ l 0 SO . 00
Name N: V,: \v
Address: SAM! /Es A(SD�.Q.
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
City: four t-B ectp State: F (.-
Zip Code: 3,� k 1 Fax:
Phone No. -1--1 t - 'A -1.57 - `-t <<'-�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Gc,-rA (--err,S
Company: L f to —b_f�
Address: l i► _S� S Q S l+-„} 1
City: c e C Le- State: F7 L
Zip Code: _51-t q &- D- Fax: AZ1
Phone No -11 ? - (o Zl -k 2 4 Z
E-Mail C-celJAJn10:ryC, VC l . Co H
State or County License (F(_
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
MORTGAGE COMPANY: _ Not Applicable
Name:
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 OW THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y9,9111 LENDER OR AN 7ORNEY BEFORE RECORDING YOUR Ndbe.E OF COMMENCEMENT."
Sig ture of Ow er/ Lessee)"Contractor as Agent for Owner
Sign a of Contr for/License Holder
S ATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF t �: C\
The forgoing instrument was acknowledged before me
this lut'- dayof J l 20 Co by
The forgoing instrument was acknowledged before me
this i,4"`day of 1 , 20 Zap by
l9 G� I e ��,` S
i car ✓� 1 e r-r, `
Name of person making statement.
Name of person ma ing statement.
Personally Known OR Produced Identification
Personally Known �OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Flo a'"y� Notary Public
Kerri Lee Hit
f�c My Commissi
ommission No. 96 3fo 1 �dZ t Expires 08/19 2
(Wn1iture of Notary Public- t t of Florida)
a�►r Ngta� P� }+Dlic State of Florida
Commission No. +p 1<4K fie Hite
GG 36-I Lo Z g My Commission GG 367402
d Expires 08/19/2023
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