HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: b -20 Permit Number:
COUNTY
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:
PROPOSED IMPROVEMENT LOCATION:
Address: I IA
Property Tax ID #:—`A q5'--vo [) [ LA - CX)o - Lot No.
Site Plan Name:
Project Name:
CONSTRUCTION INFORMATION:
Block No.
Additional work to be performed under this permit -check all that apply:
21r,Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction. $ _ �UU
OWNER/LESSEE:
Name PV\c-,o_
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
City: c State:
-
Zip Code: Fax:
Phone No. _10� ' - -�-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: \LNaVC0
Company:
Address: as u
City: kCr\ State:
Zip Cod : r)DC4 C Fax:
Phone L-1 _�� 1-11-1
E-Mail \
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
Name:
Name:
Address:
City:
Address:
City: State:
Zip: Phone
Zip: Phone;
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Name:
Name:
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
Not Applicable
tate:
_Nat Applicable
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 LENDER OR AN ATTORNEY BEFORE RFrnROINr. YnuR NnTIrF nF rnhimpurrupyT
Sign &:n_t?Zktdr/Lic`&i1e Holder
Signature of caner s e ntractor as Agent for Owner
STATE OF FLORID
-
STATE OF FLORID
COUNTY OF
COUNTY OF t`
The forgoing instrunaent was acknowledged before me
this day of 20T—' by
The forgoing instryinent was acknowledged before me
this day of 20_&)by
p
LA
1�
Name of person making statement.
Name of person making statement.
Personally Known OR
Type of Identification
Produced Identification
Personally Known OR Produced Identification
Type of Identification
Pr duced
Produced
ri
nature of Notary Public- St 4i aWanda E Mercado
My romrniss�:�i r;r t 61 t
C mission No. a,w edl 1 0812ir2a:
( ignature of Notary Public a aitlf4liloridory PuNic State of Florida(
Wanda E Mercado
mmfs� nn GG 136118
Commission No. ' (US 08122r2i, '
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.