HomeMy WebLinkAboutPermit App All APPLICABLE INFO MUST BE COMPLETED 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 Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: %0'� �f.
Property Tax ID#:_3'-�C�ti �C71 OQC�t-I -G'�CSC _ O Lot No.
Site Plan Name: Nf�r-;5 Block No.
Project Name: \AC r ' S
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical —Gas Tank _Gas Piping _Shutters V Windows/Doors
_Electric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �_�S�_ ,� Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name � Name:Edward B lean
Address: !_�G, , ��rL=A y�;����� Company:Integrity Home Builders of the Palm Beaches
City: 9:100 `,C-mg.,_ State: 91,_ Address:231 NE 29th Street
Zip Code: 3Lt Fax: City: Boca Raton State:FL
Phone No. 561- `I LA\-oCaG-Mj Zip Code: 33431 Fax:
E-Mail: Phone N0561-715-8168
Fill in fee simple Title Holder on next page{ if different Mai .
from the Owner listed above) fate or County License 'Z.
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: 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
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."
Signat Ire of Owne ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLOR
COUNTY OF \ram Utz c.�h COUNTY OF \n. �2ce t'
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this�day of ��L"" •20,2D by this day of 5'tnitnsbr/ .2070 by
")�V 1 r1OS'�'it CC�WC.[A L+2�Cl�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( Ignature of Nota
c k" . CHRI. A A BROWN ISig—nature of M
; .• ; w' CHRISTINA A BROWN
Commission No. 'E MY COMI�j�sIQN#GG063030 Commission N ; MI5SIOt�9R8p063030
EXPIRES January 17.2021 �'••• 1, EXPIRES January 17,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.