HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I? —fc _"11'_X0 Permit Ntimber:
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:
Property Tax ID #:
Site Plan Name:
Project Name:
Building Permit Application
Commercial Residential
Lot No.
Block No.
Additional work to be performed under this perrfiiit - check all that apply:
_Mechanical _ Gas Tank - _ Gas Piping _ Shutters _ Windows/Doors
_ Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 3 C Sq. Ft. of First Floor:
Cost of Construction: $ C Q C Utilities: _ Sewer _ Septic Building Height:
Name III
Address:
City: i �_ State:
Zip Code: �i Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Y1 I va C. CT . /-FnYI (Larl-cr
Company: CC K-+er ALI 04 (
Address: & 3 La Ic K d
City: t Stater
Zip Code: Fax: Z ;�
Phone No�7:)
E-Mail mac: -T'ey`
State or Coufdy License S
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.
INEER: Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 (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 work or recording your Notice of Commencement. I
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA i - �` "
OF
STATE OF FLORIDA
COUNTY -ji tit
COUNTY OFt
The forgoing instrument was acknowledged before me
The forinstrument was acknowledged before me
this! day of _ . 20 v by
this 1 day of -S v; <,1 .20`3-C by
Chi Ae.
V��.(��d1 t✓
I..
I
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida }
(Signature of Notary -Public- State of Florida )
Known OR Produced Identification
lPersonally
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced : Ieay :':'' CHARLOTTE M. WALTERS
Produced r.HARLOTTEM. WALtRS
Commission # GG 921080
Commission # GG 92108Q
Commission No. =��; ., ,.. `s" Expires NovM*1gg4, 2823
Commission No. `-w� : o Expires November�� 7019
nded Thru Troy Fain Insurance 800-386.7019
` •FOF F ;° ' 80nde Thru Troy Fain suranc 800-385
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COMPLETED
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