HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
LOCATIO
Address: /096/ S'
Property Tax ID;
Site Plan Name:
Project Name: _
Permit Number: -,�,646
r
Building Permit Application JUN 2 G 2020
sting De .rlmenl
Commercial Rlidential' de runty, FL
Lot No.
y-Block No.
DETAILED DESCRIPTION OF WORK:
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- $ As OOC� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:.
Name Z/-t �vSti.c
Name: GFi eC t< 2
Address: /0957
company:r%S�
City: 7P�Sey 15,e-4Lf-f State: LC
Zip Code: Fax:
Phone No.
Address:_1r9-Oc>
City: .ST--t e7o L 1 State:l=L
Zip Code:-?VF5FF `/ Fax:
Phone No C772-) Z 2-0 --?& ZS
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 4�/R All
i
State or County License L7 007
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:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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.
1 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 RECORD D AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN)FINANCING,
ONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y91J OTIC OF 941IMMENCIMENT.Y
Z&k
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/LicPse Holder
OF FLORIDA 7 I�1 /LL
Ji�
STATE OF FLORIDA
ai�Yl
0 - 2
TYOFW
�`
7ze f going instrument was acknowledged before me
COUNTY OF
The for oing instrument was acknowledged before
LL�� r
O dNgz
N
{las day of iU��. 202-0 by
this day of �A_n P . 201-0 by
C/
1 l
moo. EE
1
��EE o
#N'ai2 f person making statement.
Name of person making statement.
G w^
p
ally Known OR Produced Identification
Personally Known OR Produced Identificati
m
ytpo
f Identificatio q
Type of Identif cation
4
od ced L) CPnsC
Produced
(Signature of Notary P blic-State of Florida)
(Signature of Notarly Public- State of Florida )
Commission No. QI 9a..0 3 (Seal)
Commission No. 1&3 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19