HomeMy WebLinkAboutBuilding permit appAll APPLI/CABL IN O MUST B COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l
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
PERMITTYPE:
PROPOSED INPROVEMENT LOCATION`:
Address: C �s�
Property Tax ID # 4oDf I G 5Ct L4
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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19 s`f r t
LCRNSTRILICTIQ,N'INFORMATION
Additional k to be performed under this permit -check all that apply:
_ echanicaI _ Gas Tank ` Gas Piping ` Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�^
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNERAES EE:
CONTRACTOR:
Name , .r\,Q-
Name:.`. l i
Addr /n,"
Company , � t tU
City: State:
Address:MWt lV�
Zi Code:
p Fax:
Cit y: - -i�-t' �_ State:
Phone No.
Zip Code. Fax:
E-Mail:
Phone No 'T �-
Fill in fee simple Title Holder on next page ( if different
E-Mail tmi i � C'c mlo CtI' s 1-c'91
from the Owner listed above)
State or County License _N; 15
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATInrm.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
— Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 paying twice for
improvements to your property. A Notice of Commencement must b.recorded in the public records of St.
Lucie Cou t"nd`pcsted on the jobsite before the first inspe If you inter ni _ obtain financing, consult
with I der or an a torney before commencing work or re rdin ryour Notice of £Commencement.
e
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF St Lucie
Sworn mr,M�' nd subscribed before me of
hysical Pressve
r nlin .Notarization
this day of ('020 by
Don J Miranda
Name of person making statement.
Personally Known X OR Produced Identification
Type £;Identification •"�'�'� k Lori Diodato
Commission # GG069258
Expires. Feb. 9, 2021
(Signature of Notary Public -
Commission No. FF945187
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev.
(Seal)
ZONING
REVIEW
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF St Lucie
Sworn t and subscribed before me of
sical Presen or Online Notarization
this ay of _ 2020 by
Don J Miranda
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification Lon tM o—dar0
Produce - Commission # GGO!
* Expires: Feb. 9,
Bonded thru Aaron I
(Signature of Notary Public- State of Florida )
Commission No. FF945187
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
(Seal)
SEA TURTLE MANGROVE
REVIEW REVIEW