HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
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: sy `a
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PROPOSED IMPROVEMENT LOCATION:
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Address: 51 rT- e r
Property Tax ID #: 1,30 c)cc) m o Qo Lot No. (:9(_1
Site Plan Name: ra o E.5 Block No. 19
Project Name:
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DETAILED DESCRIPTION OF WORK:
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_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 Constructions:
Cost of Construction:
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name
Name:
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Address: 1 SSO) an ST Company: Rtil' — er S" �. rn
City: ie'CCf State: EL Address:
Zip Code: �J4 Fax: City: �r=T IB rGT, , State- F L
Phone No. Zip Code: �� q Fax: ri70-t(o(o _J ck3j
E-Mail: Phone No a (p
Fill in fee simple Title Holder on next page ( if different E-Mail p 0► e. 0 ifY�
from the Owner listed above) State or County License d
I
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.
f SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City:
Zip: P
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
2=4�— - Pv
Signature of Owner/ Le ontractor as Agent for Owner Signature of Contrat094L-i erase Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C)"T 1,�,; C,( I COUNTY OF J �UCt e�,
The forgoing instrument was acknowledged before me I The forgoing instrument was acknowledged before me
this day of A.
} , 20 0 by this k_ day of 20ap by
:a�L
Name of person making s atement. Name of person making statement.
Ily Kno OR Produced Identification Qersonally Known � OR Produced Identification
Produced I Prod
(Signature of Notary u lic-
Commission No.
REVIEWS
C u-
:e of FI a )
V�Ib
Notary Public State of Florida
My Comrniasion G 9I2752
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary Publ
Commission No.Cv3CL`
PLANS VEGETATION
REVIEW REVIEW
C
e of Florida )
Mom N�+ La 8tata of Florldri
My Commi*iron GG 942752
.AT
REVIEW REVIEW