HomeMy WebLinkAboutBuilding Permit Applicationn
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q 1
Date: 6�s/[a 1 Qd z d Permit Number: a00 L `0 rL��
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 r/
PERMIT TYPE: Q ho-��
Address:
555
Property Tax ID #: 140 9 � �i 010 O ( - C2 0— 0 Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit -check all that apply:
Mechanical — Gas Tank —Gas Piping Shutters 2::� Windows/Doors
ZElectric ✓Plumbing _ Sprinklers _ Generator --"-Roof � Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Costaof�utiora: } (Irf(!�C �� Utilities: _Sewer Septic Building Height: Ib
Name
Name:"
Address: qayl08 Q 6% S
Q f w * `X
Company: _
City: More i5�6 GL
State: f(
Address:
Zip Code:Fax:
City: State:
Phone No. !1-1111 1%-"114fA71
Zip Code: Fax:
E-Mail: o%Jci.Y_
Lc eo4+ • cok^
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 requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
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DESIGNERIENGINEER:
_NotApplicable
MORTGAGE COMPANY:
NotApplicable
Name:
Name-,
Address:
Address:
City:
State:
City:
State-
Zip: Phone
TIP: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name.
Address --
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNERS CONTRACTOR AFFIDVlT: Application is hereby madeto obtain a permit to do thin work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit:
St. Lu cie Cou nty makesnorepresentationthat-is grantingapermit vat! authofaethe itholdertDbuildthesubjectstrueture
which is in conflict with any applicable ffcameOwners Associatfonrules lsyl Oran csvenaritstiiatrciay'resWctorprohibit such
structure. Please consult vdth your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of thisrequested permit, I do heTebyagree thatlwitI, in all respects, perform the work
in accordance with the approved plans, the 'Flor'idaBuitdirigCodesand-St Lade County Amendments,
The following building permit applications are exempt from undergoing a full concurrency review: roam additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory usesto anothernon-residential use
WARNING TO OWNER: Your failure to Record a NWee of Commencement may resuftin. pa*gtwicefor
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the Jobsite before the first inspection. If intend to obtain financing, consult
with tanriar nr an atinrnav-hp-fnrp q-nT-nrn;4nr1nP wiaynrlr nr rernrdin-P vnur Notice of Commencement_
Signature of Owner) LesseeJContractor as.Agentfor Owner
Signature of Coniractorjfscense ffolder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF %,.,.,ems. s:_,
C€ UNW OF
Sworn to (or affirmed) and subscribed before me of
Sworn to {or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Pragence or ()shine Notarisation
this SO day of �p{+0 , 2020 by
this day.of .2020 by
Name of person making statement,
Dante of person making statements
Personally Known OR Produced identification""-
Personally Known OR Produced Identification
Type of Identification
Type ofldent►fication
Produced
Produced
ignature of Notary Pub ic- State of Flor da j
(Signature of Rotary Public- State of Florida )
Commission No. 0 Q9 I.ASHAHNAIN;&O}RAHMING
Commission No. (Seal)
MY COMMISSION # GG 275060
oe: EXPIRES: Dece ha 9Q 9Q99
;•oFF;•••' Boi
ided Thru Notary Publi
Underwriters
REVIEWS
v 5OR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Kev. 516126