HomeMy WebLinkAboutBuilding Permit Application -updaed with new contractor r
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1S53 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: �l _ Q; 4C.
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Address:
PropertyTax ID#: 2 Z C7 ' 12 z — BOLO Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit-check all that apply:
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_Mechanical _Gas Tank _Gas Piping _Shutters -W,indows/Doors
I/Electric _Plumbing —Sprinklers _Generator>1- . . .:• . Roof. Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ lD, 00 Utilities: _Sewer Septic Building Height:
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Name
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Address: 26 •Bscsc Sc�u-�- Company'. �W 1E
City: �1`, �iey-�.e State: Address: ea eL1ac�' - l&
Zip Cod e,;,ol3'��'9yJr Fax: Cit f"�y ) �. i i G �` '' ' State: I
Phone'No 't ,r! :' ' 6� Zip Code: 35i' Fax:
E-1Vlail:,tV + o ✓i►s Covl Phone No -2
I'd in fee simile Title'Noidet on next page ( if different E-Mail
frerm-the OyAiKbe�listed above) State or County License
If value of;constFuctipnl�; `0 or more,a RECORDED Notice of Commencement is required.
If value of.H:�(AC:is$7500tor more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applica ble
- Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
me: Name:
ress: Address:
: 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 IMPROYEMENTS 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 CO ENCEMENT."
*nature of Owner/Lessee/Contractor as Agent for Owner Signature trac r/License Holder
STATE OF FLORIA STATE OF FLORIDA, s�
COUNTY OF 'S _ COUNTY OF r {-
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The forgoing instrument was acknowledged before me The oing instr en`t as acknowiedgecq before me
this day of q p ,N 120 0.1 by this day of 20 by
V�. \Qo AAwt r 3
Name of person making statement. Name of person m��OR
ent.
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Typ of Identification
Produced �• fl 6• Prod ced
(Signature of Nota 7 1&,.5 ate of Fi umt<IVENS (Signature of Notary ublic-State of Florida )
•moo. Gr , Notary Public State of Florida
Commissi NH 086359
At Commission No. (Seal)
Commission No. � Comm.E$9 Jan 28,2025
of Fv,
Bonded through National Notary Assn. ��11i1111111/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION iy ' • Ird ROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW 10,Zo���W
DATE QF
RECEIVED
DATE :
COMPLETED
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