HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUS E G,c, AETED FOR APPLICATION TO BE ACCEPTED" ,,nnII
Date: r--- — Permit Number: �1f�
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
Address:
Property Tax ID #: 0 06 — 0 D O/' Lot No. o�
Site Plan Name: / Block No.
Project Name:
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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: 3-614 Sq. Ft. of First Floor:
Cost of Construction: $ �SlJO Utilities: —Sewer _Septic Building Height:
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OWNER LESSEE : `� _ r �: , ; . s�$z2
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CONTRACTORt��
Name /? ewly 2 16�U 2q
Name: Af e 'f/
Address: W /S—/ .S"T
Company:e,,��
City: &/;f o%l s� 91 i e-S' State /
Address: 997 tiC ,Orki e t wo .rT
Zip Code: 3 0 / Fax:
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City: e .,v-ram � State: -
Phone No. 3 0-5— — 5-R 7"
Zip Code: Fax:
E-Mail:
Phone No — 0 — 3
Fill in fee simple Title Holder on next page ( if different
E-Mail ? t Al 40 Q'p l 0 e viC
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.
SUPPtEIVIENTAL
CONSTR
( N LIEN I UU IN6
O.RIVI ONE w
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DESIGNER/E GINEER:o
t Applicable
MORTGAGE- COMPANY:
Not Applicable
Name:
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Address: _ 0 A 0 5-
Address:
City: ca
State:
City:
State:
Zip: 9sy Phone 77a
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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
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 YOURMENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE 9F COMMENCEMENT."
re of
STATE OF FLO
COUNTY OF
as Agent for Owner
The forgoing instrument was acknowledged before me
this � day of � 20� by
Signature of Contractor/ ' nse Holder
LORI STATE OF F
COUNTY OF LT ZCGG'l•E
The forg . g instrument was acknowledged.before me
this ay of L 20Z by
NAI?X zt!Aa n�� I �� �4Z. 2�6_
Name of person making statement. Name of person making statement.
Personally Known A— OR Produced Identification
Type of Identification
Produced
Personally Known_ OR Produced Identification
Type of Identification
Produced
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ignature of Notary P li State of Florida) (Signature of Notary Publi ate of lorida )
Commission No. �7 ya3 PublicStello� m ission No. �� '
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�' ; Sher18F'ZiAjQI Notary Public Stets or
�0�V. �, Sh f ene,F Zis1a
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REVIEWS FRONT NWT+ S VEGETATIONCOUNTER REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETED