HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COiv rcm i ED FOR APPLICATION TO BE ACCEPTED y
Date: �L-rJ�y�� Permit Number:
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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
PI RMITTYPE: 10 Y.
`PROPOSF_DiNPROVFMFNT'LOCATION,w 4 « „*,:'::.. ,•:,_ I , "'A ,' + 1., ;` ; k..' - a.., I
Address:
Property Tax ID #: 4D
Site Plan Name:
Project Name:
r
1,,,b TAILEDDESCRIPTIO.N OPWORK',, , . ','-
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters`
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: rx_i Z Sy'_ 4k Sq. Ft. of First Floor:
oa
Cost of Constructionr$I ISaD Utilities: _Sewer _Septic
Lot No.
Block No.
4 3:
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_ Windows/Doors
Roof -Pitch
Building Height:
1OWNERJLESSEE''''
CONTRACTOR i'
'; r,
(NaroeQ C&A"S;-1L-LIP
Name:
LAddress: 101 o 1 S' OCA-6
Company:
City: State:'�tLL
Address:
City:
r7 State:_
Zip Code: 3c%Q57 Fax:
Phone No. 567 - (eLf 3
Zip Code: ' AN
Phone No
Faz:'
n
E-Mail: 6PLV -e-lt .AQ 6Zz/94-00;rr�+x
Ill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.-; y;
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
IN
SUPPI NJ IVTAL'PON TRUGTION.I EN,LAW (NFOf?kMrAAT10N
11
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE. COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
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 arid 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signa of 0 wner/ Lessee/Contrac or as gent for Own
Signature of Contractor/License Holder
STATE LORIDA
STATE OF FLORIDA
COUNTY OF S - 4 at (A'Q
COUNTY OF
The forgoing instrumprit was acknowledged before me
The forgoing instrument was acknowledged before me
this _Z__ day of WPU 4 . 20_Q by
this _ day of 20_ by
S 1)7� rrPp, O
Name of person making statement ' -- ''
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced n��' �!.
Vy \J.A AAA V V
Produced
(Signature of Notary Pub' -State of Florida)
(Signature of Notary Public -State of Florida )
Commission N
Commission No. Seal
(Sea[)
4_Stato o} F Err dla•Notery Public
L060.1
,_yr
ti
4p eA' oMy
r'QA,202
ommission Ex)ires
REVIEWS
2 VISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER'
I REVIE
EW
REVIEW
REVIEW
REVIEW
REVIEW
EDATEVED
LETED
nev. 7/Lo/18