HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:�?�03 ' U� (jp
Building Permit Applicati®n
Planning and'DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT TYPE:
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Address: L1114 "2lY'I1-�c�1 lrtlA�/N� SIC. a7 F',ert.0 Az 0-11Ba-
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: Bead
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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 Construction. Sq. Ft. of First Floor:
Cost of Construction: AF901ft- 21o0' Utilities: —Sewer —Septic Building Height:
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Name�� L ent�4/'S Name.._
Address: V/!L LJAyw�e. >�tJ[ Company: y ~
City; '����� State:r-L Address
Zip Code: JYJPF,,C1 , Fax: City:
:State:
Phone No. 77-c-4 -t171.02;wo Zip Code
E-Mail; r C...��a�-r �Yyhe�d .Lie»•, Phone No ;r
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or C my 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.
1DE0SIGWNER/ENGM1NEEER:'7'-: Not Applicable MORTGAGE COMPANY: -=�Not,Applicable
me: :Name:Adress: 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 Coup makes no.representation_that is granting a permit will authorize the permit holder to build the subject structure
which-is•i*521ict with aciy` ppligg-We;,Hpr�e Dv�Rers Associatiort_rples,bylaws or and Covenants.that may restrict or prohibit such
structure.Please consult with your Home Owne6-Association a•h .review-ybur..-dieed-for any rest"r;'ic i�otii's which. y apply.
In consideration of the granting of this requested permit,I do hereby agree that I,will,in ail 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 anothertnon-residential use
"WARNING TO OVYNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT.IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MIDST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU JNTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFOREWECQ O N4 B!YO 140IT, E OEc COMMENCEIMENT:';'-
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA jj STATE OF FLORIDA
[.te
COUNTY OF f gr�I� a.•a 9:pLPA �-/ COUNTY OF
The rgoing instrument was acknowledged before me The forgoing instrument was acknowl ged before me
this day of n 2(b_L by this_day of 20_ by
Name of person making statement. Name of person making sta meet.
Personally Known OR Produced Identification Personally Known OR Produced Identification
hype of Identification Type of Identificatio�F` ttiN
Produced Produced
4 { i
nature of Notar Public-5 e of Florida (Si gnat off,Notar Public-State of
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Commissi LASI 61mmission No.
EXPIRES:December 20.2022
REVIEW PERVISOR PLANS VEGETATION SEA TUR'i'L1� MANGROVE
COUNTER REVIEW REVIEW RENHEW= '�' U(LW, yiz5s +f EViE 1(71 REVIEW
DATE
RECEIVED
DATE
COMPLETED