HomeMy WebLinkAboutBuilding permit app, page 2All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
® 11
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
PERMIT TYPE:
Building Permit Application
Commercial Residential
PROPOSED IMPROVEMENT LOCATION: I
Address: r VA T I L r, v �- ` a `' r "� (�
Property Tax ID #: -1\ 6 Jy� 1 W Lot No.
Site Plan Name: �C �r(ir�1J�� � t ,�u� Z \f- V- Block No. _
Project Name: irrGAO Ll.\
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator
Sq. Ft. of First Floor:
Windows/Doors
✓ Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
���
Name � CilY1 1S CO �t.{:7
Name:
C�'n _
Address: 1' m �UMCA v
Company: 5)-Pnfln -k(M CCX UR C 1(An.
City: P�—`� � 16� .-i State -a
Zip Code. `v Fax: 1
Phone No. - q1 `� �� 1
Address: 'LLI50 3 US /1
City: 6uy I Stater
Zip Code: �� a s� Fax:1
Phone No (r �' H �Ll �—
1�2
E-Mail: `('CA�ii1L fdC>h�3( P' -�(}�'j'Yl�1l� CC�'I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail wjnk''t�' e owmRam U cSS• co
State or County License
If value of construction is $2500 or more, a RECORDED Notice of commencement Is requireu.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
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
"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
w!rN Yni in LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOF�QA
FLORIDA
OY
�n Q�r I ^
COUNTY OF l✓ (J�� ` �I i l.N \
COUNTSTATE
OF Q.6 � � )
� � � rn ����.LI
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of , 20_ by
this day of , 20_ by
Name of person making statement.
Name of person making statement.
Personally Known ,/ OR Produced Identification
Personally Known VstOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced_
9/�a
talA is
(Si nature of N y Public- Sta a�latasha Andrea Salazajt�uire
of NotaryP c State # FI iMy
Commission GG 29660
fires O1/30/2023M
CommissionNo. ZP�O 0"` Se
.1*r Notary Public State of FE
tasha Andrea Sala
ission No. q�L003 ( gV1�jCommission GG296
Oa p Expires 01/30/2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
ev.