HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nbmber.
■I
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
PERMIT TYPE:
Address:,�C /
Property Tax ID #: 13 60 I ` a C " 6)6 —Fs_� Lot No.
Site Plan Name: 5 art L-c, Le5 fVt V-'V CC Block No. 6-3
Project Name: 6 i VL
c M c .
Additional work to be performed under this perifiit - check all that apply:
—Mechanical. _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 'god Sq. Ft. of First Floor:
60
Cost of Construction: $ r, %L/ C) Utilities: Sewer —Septic Building Height:
Name I Name:
Address: r92 Gt� Company: C4Y rAtu fk (flood
City: l �E_ t State:_ Address: 3 e- c kcJ
Zip Code: ,3 d ( Fax: City: ( - State:
Phone No. �",3 3 �. 5 Zip Code:-- Fax: 7 ? 2 - Z&
E-Mail: Phone No��
Fill in fee simple Title Holder on next page (if different E-Mail lC -7-ei^
from the Owner listed above) State or Cou y License
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.
Sl1PPt�IN' �a1Vi41 lEN3lAt�C3R1iT`it[
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
any Home Owners
Which is in conflict with applicable 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wok or recordin your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA r�
`
STATE OF FLORIDA
�
COUNTY OF j �,v� c. , =
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of . _7S �- 20 by
this day of 20 ":X) by
A A Cc,
401 C�V'J
V (C("q vi o vi-cfi'
�
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known
Personally Known ~ • i -t o
YP '•,
Type of Identification CHARLOTTE M. WALTERS
rP •, CHARLOTTE M. WALTERS
Type of IdentificationFit
Produced =_: :,. Commission # GG 921080
Produced ssion # GG 921080
a= xpires ovember 24, 2023
=i�F•. oP:
EF .• Bonded Thru F ' Insurance 800.385 70f9
Commission No.
,;�; Expires November 24 2023
o?•
,Commission No. Ff .• Bonded ll"FainInsurance 800-38&701
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Rev. 7/2014