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HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ,j` .L 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: 'r PROPOSED IMPROVEMENT LOCATION: Permit Number: Building Permit Application Commercial Residential Address: �i't)u '-� �'_kt2'L Q(A01, t, i nac �- A--��`i' • ti X Le k [_._`iN I PropertyTax lD #:. �7 �ra 7 -76/ -6610— ©a -J -- Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional work to be performed under this permit- check all that apply: _Mechanical _ Gras Tank _ Gas Piping _ Shutters T Electric v Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Cost of Construction: $ Windows/Doors Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name C S Name: 41 Address: 30 C400 e_ ( yrr City:. A-e'_CA_ StateFL Zip Code: &Vf c `/ Fax: Phone No. Irl 72 r Ali Sr'/� k4l__ Company: Address: C' It City: ;. r�, r r State:��-- Zip Code; ��" � Fax: Phone No_1-77- V6, 5 E -Mail: %c/0n ® ® /. � . ,/1 _ Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail f C7 �r �r� ,it/G/? State or County 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. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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 structure. Pleasecconwith sult with pyoiurHle Home ome Owners Association Owners Association nd review your deed aws or for any restrictions covenants that which may arestrict or ly. prohibit such 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMPK&MENT27 Signature of owner/ Lessee/Contractor as Agent Owner Signature of Contractor/License Holder STATE OF FLORID r STATE OF FLORI ' COUNTY OFA_t�JL.�CL�COUNTY OF ti The forgoing inst ument'w acknowledged before me The forgoing instrument wasa knowledgedbefore me this_ day of _,L_ 20'�IC)by this day of - 2 &by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known �� OR Produced Identification Type of Identification Type of Identification Produced Produced OA"". (Signature dUff4tary Pu ic- State of F o Ida) SignaturNo ry Pu ic- State of ida ) Commission No. (Seal) Commission No. (Seal) ANGRO REVIEWS I CFRONT ZNINGOUNTER ! ROEVIEW $ REVEWOR REV W UPERVISS I V REVI WEGETATION 5 REV EWEATURTLE IMREVIEWVE DATE RECEIVED DATE COMPLETED