HomeMy WebLinkAboutBuilding Permit Application All APPLIC INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� O., r
Date /4 Permit Number. [�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 J
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address:
Property Tax ID #: 665_(z Lot No.
Site Plan Name: Block No.
Project Name:
ji4 ` �'� a-) e�r�b��art� .�' �c2 y► sQ��-ia vts
)n Qmor-A a11j2a '10 eDhca 2
as
d 7V- s
_ f
Y
a�
`'�ca.^_ .�'-"�-�^..
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:' 325 11h / Sq. Ft. of First Floor:
Cost of Construction: $ �-50i�2a Utilities: —Sewer' —Septic Building Height:
-.�` 's2r. `3,ti �.- .s�i �s +3. i, .'-�,^�- ; a$3it' 3 _ --
}E _ =r3- "�"y- -�
01
Name Name:y
Address: 1f.Gf i Company:
City: i /� G Stat Address:
Zip Code: Fax: City: State:
Phone No. �/�00 Zip Code: Fax:
E-Mail: �'/ff 7 /1'o.0• Phone No
Fill in fee simple Title Holder on next A g Q If different E-Mail
from the Owner listed above) State or County 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.
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 permitto 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..OIYN : YOUR...FAILURE TO RECORD A'NOTICE OF COMMENCEMENT MAY RESULT IN Y0I)12 SAYING
TWICE FOR ZVEIRi
ENTS TO YOUR.PROPERTY..A NOTICE OF COMMENCEMENT MUST, BE RECORDED, AND
POSTED ON .SITE BEFORE HE FI INSPE ON. IF YOU IN�'END TO 06TAIN FINANCING, CONSULT
9�9TI1 YOUROR A EY.I3 ORE RDING YOUR NOTICE OF COMMENCEMENT."
Sgnatur f n / e ee/ ont ctor Agent for caner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instrument was acknowledged before me -The forgoing.instrument was acknowledged before me
this day of 'xAL FV 20, J by this day of 20_ by
Name of person m ing statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of identification Type of Identification
Produced �_� ��, Produced
(Signature of Notary Public-State of VArida) (Signature of Notary Public-State of Florida }
Commission No. ,�n0v Commission No. (Seal)
EC
'sa State of PEN V
IV
M't1(Yll'gio a'Notary p
REVIEWS FRO INGy t'lr�� d,011SW Iic LANS I VEGETATION 'SEA TURTLE MANGROVE
COUNTER R /res VIEW 'I . REVIEW REVIEW RE>/IEW
DATE
RECEIVED
DATE
COMPLETED
ev.