HomeMy WebLinkAboutBuilding Permit Application l
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 / 1112-1-1 Z 1 i
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
PERMIT TYPE: CIL
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Address: ��b S W /� �-osa (3�"� For ��. �tic`e 0-1 arr� 3Y9cP-3
Property Tax ID#: 311 5qS- (50:>4` oc)ol ' Lot No. (o
Site Plan Name: CVCR R4R - CA,,-.4 (n Block No. O
Project Name:
-Le-, on, J94 .S-C(� Qf cr<�'G:.'tia Ra,s' -�...«e. J m
9�anc 1AJ4S';Je_ TD•j¢r-�l rt-Ar 4./0..q Yegr W -A / Galt 0—+
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping i Shutters _Windows/Doors
Electric _Plumbing _Sprinklers ^Generator ^Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3�5D . Utilities: —Sewer _Septic Building Height:
Name Name: - - - -
Address: 4F60 SW -4z,-e,l0 131v4 Company:
City: Por-+ State:�� I Address:
Zip Code: Fax: City: State:
Phone NoP 72) (p Z(,,- 7,�PS6 Zip Code: Fax:
E-Mail: A-:L11a;fe./97c) Q e, w�¢: �(c yy) Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
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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.
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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 corisideration of the granting of this requested permit, I do hereby agree that.l 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. 1N YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST DE RECORDED AND
POSTED ON THE .IOU SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig tune of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
I STATE OF FLORIDA � STATE OF FLORIDA
�
COUNTY OF , i(1�Z COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1_day of _hn 20:0 by this_day of 20_ by
cua. \A
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat' n Type of Identification
Produced L Produced
TA) 21��-_
(Signature of Notary Public-Stat Florida ) (Signature of Notary Public-State of Florida )
Commission No ."aYd'%, ELLEN (,�A#GHN Commission No. (Seal)
:State of Florida-Notary Public
Commission#GG 270079
%1OFF�°P ommission xpires
REVIEWS - 3 ._ -;22 -0 OR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIW REVIEW .REVIEW REVIEW: . REVIEW
DATE
RECEIVED
DATE
COMPLETED.
Rev. 2/7/19