HomeMy WebLinkAboutPermit AppAll 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
Address:
Property Tax ID #:
Site Plan Name:
r�
Project Name:
CONSTRUCTION INFORMATION:
Permit Number:
Building Permit Application
Commercial Residential ✓
Additional work to be performed under this permit — check all that apply:
Mechanical Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: :a) 30o
Cost of Construction: $ �`�jy 00 0 .
Generator
Sq. Ft. of First Floor:
Lot No.I�J—
Block No.
_ Windows/Doors
✓Roof 9 Lf2 Pitch
r
Utilities: _Sewer _Septic Building Height: /9
OWNER/LESSEE:
CONTRACTOR:
Name
Name:(��
Address: 'A2\b R.e�1z,rQQ x n.11 'lr_
1
n � Company: Lon An�w;iruGT1OA
City: ?nr-N S'-IicLvc'le State:IEL.
Zip Code: 39 Cc Fax:
Phone No.
Address: 39SCA 3v.rt-ns
City:?a&*-_ &WJn State:FL_.
Zip Code: 3 2241 t7 Fax: SCot - C 5-C) 32A
Phone No S(0 i- q 39- ±4a "I
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
I Q.00 ,Lm 112Om e of Gk)bg h nt
State or County License irk 13 2- b `F OA-
If value of construction is Sz!)uu or more, a ntwnocu notice m a .may..,.=...
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 I MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
M.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 perm,t 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."
for
Signature Co tractor/License Holder
Signature of Owner/ Lessee/Contract s Agent Owner
of
STATE OF FLOI
STATE OF FL D
COUNTY OF Y� ���
COUNTY OF �{ S J_f�QQ
The forgoing instrumen was acknowledged before me
The forgoing instruRient was acknowledged before me
this _1 day! of 20_y
this day of 2¢ by
1`{' L k L )
Name of person making state me t.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
L��ia�1_iP_'Q
(Signature of NitaryaPer +>—e- tateal laM *R
(Signature of Notary Public- atevo on a HELLS SAWYER
;cam Notary Puq is - late of Florida
'F,:`;,%°4j1 N r ublic - State of Florida
Y
Commission No %'�: %�` Comm, # 98
Expire 2020
+.
Commission No. i° #ss,on#GG32898
. ,
'
,.. :'' M
Y Comm. Nations Sep 22,
Bonded through National Notary Assn.
Ass
Bonded through National Notary Assn
REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 277719