HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST
�' �'
COMPLETED FOR APPLICATION TO BE ACCEPTED
�'
%,,
R.
Date:
Permit Number:
I V
"'
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Property
Building Permit App
Commercial
Permitting 6epa,rtment
St L C FL
Site Plan Name: Block No. J L
Project Name: rr t�P �e G1�C l� oo� P Gt�C
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: $ COO -- Utilities: _Sewer _Septic Building Height:
Name =1L )f-t's�'� (-,— Name:
Address: IC{�� IBC 1l)Gt
� ._1_ Av E' Company:....-.',-
City: 11'�C'� �J ` �t �c -e State' Address:
Zip Code: 3qq403 Fax: City: a State:
Phone Phone No. ";L- .3 o Q- 0 `f % :7- Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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 CNEORMATION F m° r �� y
Fry
� r
,.::.
DESIGN�R/ENGINEEEER:S
of Applicable
MORTGAGE COMPANY:
_ Not Applicable
NN�,,``
Name:
nN
!s tp ,r 1
Address:
City: e-<-o
State- L—
City:
State:
Zip: 3d Phone: �
r'
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 thLp 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 inspectti�on. If you intend to obtain financing, consult with lender or an attorney before
commencing work oXecording youlAotite of Commencement.
_ Si gr fM7-(bT-Owndr/ ass /Agerr tN
STATE OF FLORIDA
COUNTY OF G'1• Gwa•--{
The forgoing instrument as acknowledged before me
this � day of 20 /_by
(Na a of person acknowledging )
TSignallure of Notary P- State of Florida) lV
Personally Known ✓/ OR Pro ced Ide fica ' n
Type of Identification Produced 09Wti-PA
IF
Commission No. && (Seal)
oft
JOSE G ACOSTA
;_ffl�,'=Notary Public -State of Florida
Revised 07/15/2 Commission # GG 028448
`. My Comm. Expires Sep 8, 2020
s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20 by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
(Seal)
Bonded through National
Notary Assn.
REVIEWS
F
S P R IS R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS