HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: � �o�� Permit Number:
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Building Permit Applicatiortzi 0 do\�
ert
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
Address:
ePax"'M
Pevott�� e coo
St.
Residential 1/
Property Tax ID #-i1-0 r
C-5 Lot Nor
Site Plan Name: Block No.
Project Name:
I�'DE- AlLED'I�ESC-RIP'TIQN,OF WORK: (�Q2(}�
0
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric pA- Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:�� /ram -�,
Cost of Construction: $ .:>Zk �J� )
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:_
Name TaVlrry 13emendf-r�ee
Address. '9 ! eemIYobe_ T
City: 10tef',4f State:e V
Zip Code:34 J 1 . Fax:
Phone No. ?a c94
E-Mail: *Am b't,(.f'aeir I�•� _ `�✓i
Fill in fee simple Title Wolder on next page (if different
from the Owner listed above)
Pitch
CONTRACTOR -
Name: PLew,1sari 6 f C ADI`L S1 S
Company: &U Ls
Address: UU $ S-W 1��I h jp5f.- 09 y 5�
City: �g4lLar �— State: F1_L
Zip Code: Fax:
Phone No 170
E-Mail e
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requireedv
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: ik ne_ ne_ W Name:
Address: ,ei-a.l A44Address:
City: berler-Awdh tech tate: rL- City: State:
Zip: 33U ( Phone ( 4) A I8^ 3S2,5- Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
vlAot Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
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 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
wrru vnnD ii FNnFD nD AN ATTnDNFY RFFnRF RFcnRnING YnHR NOTICE OF COMMENCEMENT_"
Signature of Owner/ Lessee/Contragas Agent for Owner
Si nature ontractor/License Holder
STATE OF ;,,/j t `
STATE OF FLORIDA
r r�'V
COUNTY OF � (1�-�-1/v�J
COUNTY OF 1'�
m
The forgoing instrument was acknowledged before me
The forgoing instrur�ggnt was acknowledged before me
this _2L day of Nfj-/ 20Iq by
this U day of 20A by
Name of person making statement.
Name of person making statement.
Personally Known 1_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
r—
(Signature 0 Notary Public- State of Florida)
(Signature of No ry li - a
Commission No. ;:1rA�P4':, LISAJANE(gNO
�vr'6 LISA JANE SERRANO
Commission No. /:°,� NotaryPubtit$��j{>�ofFlorida
„ Notary Public . State of Florida
=; • ` Commission q GG 930079
z�• `° Commission # GG 930079
''.?"oF� My Comm. Expires Nov 7, 2023
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