HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPL'.�-r..O FOR APPLICATION TO BE ACCEPTED - f Q
Date: o % 202c� Permit Number: �./� �J 0
Building Permit Applicotion AUG 4.2020
Planning and Development Services
Building and Code Regulation Division (C�•,. i ; '''- `;.� r' `: '" "` i i ��
2300 Virginia Avenue, Fort Pierce FL 34982 0.,L ut Z_'J C! _' . (-
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 1/ Residentla'l
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION "
Address: �? ?6-V 5 D ® I_ utj yr 9 3 (o, -Iwo z Fl,
Property Tax ID #: &6-35 - fo 0 1 - ® 6 10 " 0 C' 0 - 6' Lot No.
Site Plan Name: A42054-yi11- Caw 0M I"J1 A4yJ Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ZZ l
;CONSTRUCTION]NFORMAT, ION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
electricmbing _Sprinklers _Generator
Total Sq. Ft of Construction: _ o Sq. Ft. of First Floor: _
Cost of Cv fir$ = i05 Utilities: _Sewer _ Septic
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESS.EE
CONTRACTOR:
Name 661/
Name:
Address: fgZO S 61A W, D Q2 Tt- 9,36
Company: 1 IM G�c,i CJ- 21 E�/�'{
city: GA State: J--b
Address: /'/off /ihi� /z'y,g,
Zip Code: '246/ Fax:
City: ��5!✓' State: ,
Phone No. J09 �0 Zf) ?V
—�-
Zip Code: 3�/ys� Fax:
E-Mail:
Phone No -772-1r-!2 %36/2_
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License CL'C /'o9q2_1
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.
t
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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."
QJ_ (� N-1,_ -
Signature lowneLdssEe/u----u'rr-4r-ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF .e
The forgoing instrument was acknowledged before me
this-?() day of 5iZuSd , 20 0 by
Name of person mak7011
tement. V
Personally Known Produced Identification
Type of Identification
Produced
Signature of
Holder
STATE OF FLORIDA
COUNTY OF end ,Lt >1
The forgoing instrument was acknowledged before me
this
`+ a day of S 20- by
l/�y� �Jc70dS
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
`-(5 ture of Notary Publi
INEN.SToi�S
aturebFPdUt2ry Public- &rif0&MAISSI0N# Gr.13648
�•••..l. w commissioN # GG 136487
9- EXPIRES: September18,2021
Commission No.
:�• :off; EOM:$eptember18,2021
ommission No. �FgFF„°Q'9� NoteryPuM Wftwh
Bonded Thu Notary Mc Undeiw tm
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