HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S3)51"In o Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
PERMIT TYPE: C- I i (' j k I C /\_ i
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential
Address: N(-�� \7T.
Property Tax ID #: � ��" �CA"3�-"n►((7 110 -�- _ Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
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: Sq. Ft. of First Floor:
Cost of Construction: $ ili, �Aoo Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name L51� i I r;_'
Name: --)a 1e"s
Address: lko � - 1VOP1 ��
Company: �`�L I O\ F\e6 COA
Q2 6;-iLY 12 (S
City: F'} •�ep-c-` State:t
Address: 1(-)\ W \A\(N �0. "37A
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Zip Code: 3yq$ oti Fax:
City: F+ - 1erCe,
State:
Phone No. N1-5l1 6CN-o
Zip Code: Ol�c�- Fax:
E-Mail:��� @ mo0' 0-orr)
Phone No 'Ale I - 8la8'
E-Mail 10.� Cam`-
CO��
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 5Z5UU or more, a KtI.VKUtU I4011Ce UT k-UinmenLnnicnL la i cyan cN.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
MENTAL CONSTRUCTION LIEN LAW INFORMATION:
FESIG/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
State:
City:
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
Association covenants restrict or prohibit such
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andrreviewbylaws
which iin syour deed or any trict o s which may a.
Pleasecconlsult withpypolurr applicable
Owners Association
strIn 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,
and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen rooms
"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
YOU INTEND TO OBTAIN FINANCING, CONSULT
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature f Owner/ Lessee/Contractor as Agent for Owner Signare of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
A, I ► IC-1iff, COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
by
this Z day of 20,E by this '__-) day of 20,:�O
c��m�� Ica Sul c�
Name of person making statement. Name of person making statement.
Personal) Known OR Produced Identification
Personally Known 1-1/OR Produced Identification Y
Type of Identification Type of Identification
Produced Produced
t N_
(Signatu of Notary Pu i t to ofrvo��ii�s�ac State of Florida (Signatu e of Notary Publi e�� o of ry ublic State of Florida
�� Mar aret E Montepare
`� E Mon
Margaret =off
�Y1 C,C�� =off
.r My corq}y�}jor' GG 214990 Commission No. Cal yC�i : My F�e01 "O^ GG 214950
�o. S12022
�''OF
Commission Expir® i2022 Exp,res o8
W n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.