HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON,'[', -ti'ED FOR APPLICATION TO BE ACCEPTED'-
Date: to 9 , (1 Permit Number:
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 k
PERMIT TYPE:
PRC)P05ED iNPRt3Uj=MNTLQCATfON:�,..a
Address: 6151 14,+PP / n1 E55 6T- Fi P, 9-Ae6 , F4)Ai L)4 J 4et g 1
Property Tax ID#: '24[1-: !!b-(900660.11- Lot No.
Site Plan Name:
Project Name:
Block No.
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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 Construct �X_J_%r 11 @]� Sq. Ft. of First Floor: qq Yz it X -otD -C
Costof Constr rction-
Utilities: —Sewer _Septic Building Height: a' e.
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SOWN ER f LESSEE,s a, �3
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` CCiNTRAC1R
Name 6V6O ON ( , ` EVEP.UX
Name.
R
Address: �5t5l 66-PP/ryf.56:5
Company:
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City: ZIT. PILkeg, State:FLd
Address:
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Zip Code: Fax:
City: r-.
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State:
Phone No. 9-7; oP-D�5'0579
Zip Code:
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Fax:
E-Mail:
Phone
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 required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: I _X_ Not Applicable I MORTGAGE COMPANY: x Not Applicable
Name:_
Address: City -
Zip:
Phone
Name:
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
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
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement. '
�igrfature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE.OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this U day of 209k by
this day of . 20_ by. .
EVY.56/k V )Q_ rc_ c&'T';
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
L
Type of Identification
Produced r —
Produced
(Signature of Notary -
(Signature of Notary Public- State of Florida )
ELLEN VAUGHN
=2°„ .=Ste te of 96W)-Notary Public
Commission No. -, =
Commission No. (Seal)
^r _ ommis ion # GG 270079
°:�oFc��"P°' My Commission Expires
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.