HomeMy WebLinkAboutBuilding Permit Application DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applica ble
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
POS.T1 D.O TFIE J013 BTE BEFORE T1-1,E FIRST INSPECTION. IF Y NTEND OBTAIN FINANCING, CONSULT
WITH YO R ENDER," 6,1l1 ATTORiNEY,13EF®I2E I2ECO1211ING..1(OU NO ICE t)F. OMMENCEMENT.".
Signatur o Owner/Lessee/Contractor as Ag nt for Owner tore f Contractor/License' e
STATE OF FLORIDA STATE OF FLORIDA rr . .
COUNTY OF ��" -' COUNTY OF S - l�t1l
The fo ng instrument as cknowledged before me The forgoing instrumen�t�w�as/acknowledged before me
this of 20 o2�by this -(�@y of lye`I �'� 2t� by
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ft; CCU a rM i
Name of person making statement. W Name of personki manog statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification J'
Type of Identificatio�� Type of Identification
Produced 1'' Produced )k,—
(Signature of Notary Public-Stat prida); ignature.of Notary Public-State of Flori )
Commission No. oo�ii ELL ' CJGHN "" ELLEN(Fl11)G.HN
E( � Commission No. �YP�%
State of Florida-Notary Public �a �; ate`of'FloHda-Notary Public
Commission.# GGi270079 _* Commission A: G 270079
��oFe�o� ' � " vOm` rTlISSiO Expires
1 hnn�� Octobfa
REVIEWS PLANS VEG 22' 2 VE
COUNTER_ REVIEW,.-, REVIEW REVIEW REVIEW REVIEW RE
DATE
RECEIVED
DATE
COMPLETED
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number Loa't-i t
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:
.. >,� ,r*'r+ c _Mwn .
Address: /VlV
Property Tax ID#: y� �� V W� 4a Lot No.
Site Plan Name: Block No.
Project Name: g�
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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: $ 2 >���/�. r� (� Utilities: —Sewer —Septic Building Height:
4 j �"-�a �a x'Y ti
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Name 'jaev- a K. '3EV I E Name:} Vtl
Address: 1S07 AN /r3u,TEoNiSQSY CtILGA-d' Company: r$' I C
City: p A.tt C1 rV State: 124 Address: f 01Y O_Me_
Zip Code: 3 4g90 Fax: -/0,✓X City: Phrf S� j j.�}Gc�� tate:
Phone No. 772" aAl— zl 6 7o Zip Code: Fax: A
JIA
E-Mail: '-feYahGd i e r�_a1 m ac-�I- P UrY1 Phone No - 06
Fill in fee simple Title Holder on next page( if different E-Mail .1 e e � � � Q�' Omea
from the Owner listed above) State or County License c K
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.