HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 4
Date: Permit Number:. ao 1
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
'Phone: (772) 462-1553' Fax: (772) 462-1578
RECEIVED
Building Permit Application Nov 1.2 2020
Permitting Department
St. 7..
unty
Commercial Residential
PERMIT TYPE: o Sh�CQ' l 0 X k
P.ROPOS'EOyIMRROVEM.E'NT LOCATI'ON.:
A-dr ss: 5`70 L� ekt-i,) -DC. Vof'- - M PXC.-o- F 1 • �`1 `� �Sc�
Property Tax ID #: �(to 9' ® L4 C)42-).ro 00 •
Site Plan Name: <BIQ.c-k�No. �03
Project Name:
pETAILED DESCRIPTION, OF WORK:,
.CfJNS�RUCTION tNFORMATION�:- � � - .
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
Cosf ofC nstriaction$ Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OVI/NERJLESSEE _
;.CO'NTRAC -OR:: -- - - -
ame „�� iPCt^1-y�1
ddress: 5 /0(� Sir T�)n
Name:
Company:
Address:
City: State:
Zip Code: Fax:
State: FI'
p Code:5Lfct I D- Fax:
iP .one No. %� a ��� �-`i (�
1.�' ` yr
E. ail: V_&0�iA' [p � (� Vo\- rl�e 1- D
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 $z5uu or more, a KtLUKUtU Notice or LOmmenccmnnL w l cyuu
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
l.SUPPLEMENT'ALCON5TRUCT1.0N: LIEN L`A"�` I_N'FOR'M=ATION:
DESIGNER/ENGINEER: _ Not Ap
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: _
Citv:
Zip: Phone:_
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worK ana m51allat[on as inuicdLCU.
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
... .��mawv nrrnne nrrnonuuC Vn"D 1unTICF nF COMMENCEMENT."
TV! 11'1 T VUK LCIYu K A 1 ■ v■cnlv ■ u■.■ v■.� .
- -- --- - --
Signs re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
Flor i�[rr
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgging instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of N oyGnn" bze , 20.20 by
this day of , 20_ by
,ID
Name of person making statement.
Name of person making statement.
Personally Knowny/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Si ature f Notary Public- State of FlorAi k K RLI& KIS
(Signature of Notary Public- State of Florida )
Public, State of
Com on No. Cam& �7338� 21V19mmissionExp N
ids )
(Seal)
My Commission No. GG
273382
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