HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i O Permit Number:
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
Address: J Property Tax ID #: a 4 J � - Db 30- ono- I Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: —
an
1 �I
Cost of Construction: $ (l
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Name )C�a\ A
Name:
Company: ( e
Address:
City:
Zip Code: —cam
Phone No�:
E-Mail i f P
State or County License
Address: l a' L 1
City: Clf_ State:
Zip Code: Fax:
Phone No. �7 �T;/
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
Windows/Doors
oof Pitch
Building Height:
LC� Is 11 LUgM5
Fax:
_P" C::
State:
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."
1
Sikr fature of Owner/ Lessee/Contractor as Agent for Owner
Signatl of Contractor/License Holder
STATE OF FL RIDA
STATE OF FL RI
COUNTY OF�y► it �il`��/
COUNTY OF�AA dA- L il
The for oing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
�0 a by
this day of a 20 by
this day of 20
D AIM _o u ),'ua aV14S
D &41f
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica l ,
Type of Identifica;t�+'pn,
Produced UrIVA6 LtC�s-L
Produced i=(, EJrtv,r*S
(Signature of Notary P lic- Sta e o Florida)
Caitlin Vel�squez
(Signature of Notary lic- Stile o Florid
( g Y Caitlin Velasqu
ZPRy 4So
8 NOTARY PUBLIC
Commission No. STATE OF FBLIC
�1 NOTARY PUB
,Commission No. Q (� ° I r
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I
.+
u o STATE OF FL
R
Comm# GG07497
?Gomm# GG074)7
cFExpires
xplres 2/20/
0
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19