HomeMy WebLinkAboutPERMIT APPLICATIONAll AP l,ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Da e: Permit Number:
CE3t.1NTY"
-r t 0 R 1 0 A
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
CONSTRUCTION INFORMATION:
Building Permit Application
Commercial Residential C"
Additional work to be performed under this permit— check all that apply:
—Mechanical as Tank _ Gas Piping _ Shutters
Electric �IplumbinS rinklers—g — p Generator
Total Sq. Ft of Construction:
Cost of Construction: $ (,)
Sq. Ft. of First Floor:
Lot No.
Block No.
_ Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTR CTOR:
Name
Name: 2 E
I'
Addr s: �-t 1 I
Company:
City: i' Sta
Address:
Zip Code. -an Fax:
City Stat
Phone No. n QQ 3
Zip Co e::J4 N ;5� Fax:
E-Mail:
Phone No `�
Fill in fee simple Title Holder on next page ( if different
E-Mail )aAd a
from the Owner listed above)
State or County License
-�•� �• ��••�« 11RVrC, a rcca-vr%Ur U iyonce or commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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!'
Signature of Owner/ Lessee/Contractor as Agent f r Owner
Signature of Contractor/License older
STATE OF FLORIQA
COUNTY OF �� li 'i, �
STATE OF FLORID
L�_
J
COUNTY OF , I, ki K)
The forgoing instrument was acknowledged before me
this day I_��lu C'
The forgoing instr entwas acknowledged Before me
1^ C�'
of , 2 0'��y
this ,� day of ,I �.- . . 24_111�
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
K�AQ AJQI 0 1A /A
v6WK
(Signature otfi&fary Publici State of Florida
(Signature of Notao Piulic- St t of Florida )
r�.w►►.idb•
Co m S KARLEY MARIE GIESYNARNEY
%=: fFlorida ealj
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KARLEY MARIE GIESYNARNEY
Co o. (Seal)
• Commission t GG 099801
r Comm, ices May 1, 202t
• rich
Commission GG 09980t
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Mary Assn..
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SUPERVISOR
P
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LE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19