HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'j` r Permit Number:
COUNTY
F L O R 1 A A
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:
Building Permit Application
Commercial Residential
PROPOSED IMPROVEMENT LOCATION:
Address: C�L1� c,,L, NA 1 w 4 V\ tf\ r
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Block No.
J DETAILED DESCRIPTION OF WORK: I
c
[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
Total Sq. Ft of Construction:
Generator Roof Pitch
Sq. Ft. of First Floor:
4u
Cost of Construction: $yt Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name c Name: 1 �.7
Ad ess: -� Company: \� _ �l-1 mt° r c i
City: �� Stater- n.a�1�o«• LI L 1r 1 I VI r J
Zip Code: 'DLYI Fax:
Phone No. L1G A 10 S L
E -Mail.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
City: 1 1 '\ State:_t—t
Zip col: ' j?40 Sa Fax: �.l y- x/46
Phone No ^ aL�� L -i
E -Mail M-06VNVI1CCA- @.-f)-I Win, 0C/�n
State or County License_ ] �ii�p
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:
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Name:
Address:
ZONINGSUPERVISOR
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
REVIEW
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
REVIEW
Name:
Address:
Address:
City:
City:
Zip: Phone:
RECEIVED
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 ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR��ygR OR AAI &P=NEY BEFORE RECORDING YOUR NOTIg FjCOi!MENCEMENT."
actor as Agent for Owner
se Holder
STATE OF FLORIDA a STATE OF FLORIDA `
COUNTY OF �:1_1 COUNTY OF r� -
The forgoing instr ment was acknowledged before me
this -2i day of 20�uy
�'� ,, �C>
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
P duced
A-[ '
(Signature of Notary Public- State
The forgoing instrent was acknowledged before me
this --'-I day of %20,2C)by
rho r
Name of person making statement.
Personally Known -� OR Produced Identification
Type of Identification
PraeWced
re of Notary Public- Sta
Notary Public Stable of
Commission No. l I)Wanda E Mercado
my GommGo 1
orida lk6Notary Public State Of Flo
Comm ion No. r ,(S)ftMa E Mercado
i t s � + my •mmission GG 1 X61
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REVIEWS
FRONT
ZONINGSUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED