HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
era I n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential
PERMITTYPE:,�
PROPOSED IMPROVEMENT LOCATION:
Address: Q 10 � Sc�1rn1)1 1P_ led
Property Tax ID #: / 30 I - GD S OD S � — 00J
Lot No.
Site Plan Name: Block No. Z�;U
Project Name:
[DETAILED DESCRIPTION OF WORK:
L CONSTRUCTION INFORMATION;
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
_ Electric _ Plumbing Sprinklers ` Generator _ Roof Pitch
Total Sq. Ft of Construction: HD �s Sq. Ft. of First Floor: 1, /'q
Cost of Construction: $ Z0 Utilities: _ Sewer / Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name J� 6, -
Name:
Address: C i,D G - 5 .,n,�� e �C)
Company:
P Y:
City: Fi P"tr -t State: T'�-
Address:
Zip Code: 311 c S) Fax: 2 C<,
City: State:
Phone No -'0 - /
Zip Code: Fax:
E-Mail: rr. r CJ
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
K. �i .I - mot__ t_ A..
VI nwlc, a nca.VnVGV nviice oT bOIilRlenCemeni Is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
I-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
" WARNNIIG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT NY 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
WIITH YOU R AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ignature of Owner/ a Contr ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Q
COUNTY OF
The for;Foing instrument was acknowledged before me
The forgoing Instrument was acknowledged before me
this /_5 day of 20. -)()by
this day of 20_ by
J:�,�-, 5�-�-► cis
Name of person king statement.
Name of person making statement.
Personally Known
Personally Known OR Produced Identification
••4>Pv o '..
Type of Identification �� ... Nota y P o,� - State of Florida
Type of Identification
Produced = mml don GG'a3590
Produced
9 ;P 4'yComm. En,esVov7,2021
••.'�cF`:`r;;
Bcdedthrocyrnatcral\ctaryAssc.
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19