HomeMy WebLinkAboutBuilding Permit ApplicationST All. APPLICABLE INFO MU
eB,E CCO, MPLETED 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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: t d-.
Property Tax ID #:
Site Plan Name: _
Project Name: I
Residential
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Lot No._
Block No.
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14129
moil r ' r M0
Ira U41 211ri!)n, .,
1Mi.
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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 Construction: �O Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: ✓ Sewer _ Septic Building Height:
OWNE /LESSEE:
CONTRACTOR:
Name l�
Name:
Address: -'
Company:
Address:
_ t
City: 1 U I State: DL
City: State:
Zip Code; ?S Fax: 1_2 r�—'K °�—� 9
Phone No. -,q o06-a-' I
Zip Code: Fax:
E-Mail: 8mm c.l\w �) 01O Lr P cm
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.
V
ESUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 1'4_ MP5:J.l1 fwlkl
r i(n 6nQz01) INC-
_
Name:
Address:
City: State:
Address:4U,01 AE9
City: 0 State: SF-�
Zip: %9L, 11 Phone .
- -
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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
An accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
i
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
WIT",YOUR LENDER OR AN A RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature k(JVVn-er7 L steOcoritract& as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sa. I .UC.I
o
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this JJ''� of 20,% by
this day of 20_ by
,jday
1'1.yNl �,I/llti.� Q.0 C
Name of person making st tement.
c - o a
O N
Name of person making statement.
Personally Known OR Produced Identi
�
tin,
Personally Known OR Produced Identification
Type of Identification
o N � v
Type of Identification
Produced
a = a
Z V p x N
Produced
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a w Z
E-
0
YNAA1 OA&
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O T
(Sig ature of otary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.(Seal)tl
J�(�o
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19