HomeMy WebLinkAboutBUILDING PERMIT APPLICATION--ti
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 6 v
Date: Permit Number:
...._ ._._:...,. RECEIVED
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Building Permit Appli ation
Planning and Development Services I - T° _L_ - wil tY, PQrmitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: S/•, le :41/fi/
PROPOSED IMPROVEMENT LOCATION_ :
Address: cuan JDr. C165M a
Property Tax ID #: S_— 0- 0 v /0' 6 000
Site Plan Name:
Project Name: &7_ 5
,DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
,Mechanical _ Gas Tank _ Gas Piping —Shutters
4 Electric Plumbing _ n e _ Generate
Total Sq. Ft of Construction: / 0 , Z` y Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —SE
c. dO
Lot No.
Block No.
KWindows/Doors
X, Roof , 1. Pitch
Building
OWNER/LESSEE:
CONTRACTOR:
Nam J2 Ph AlbllName:
Company:
Address: oZv ie -
S Cityr�/ _Sta e: _
Zip Code 105'
Phone N0005- Q/ "' SJ ,30
Address:
City: State:
Zip Code: Fax:
Phone No
E-M 'I: r QOl I'%I iZ
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit Ito 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
PO THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
TH YOUR NDER O TTORNEY BEFORE RECORDING YOUR NOTICE! OF COMMENCEMENT."
ev. 2
SUPPLEMENTAL CONSTRUCTION LIEN .LAW INFORMATION:'
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY:
Name: �
Address:
Not Applicable
City:
Zip: Phone
State:
City: I
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City: '
Zip: Phone:
Zip: Phone:
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Owner/ LesseeContractor as Agent for Owner
P
Signature of Contractor/License Holder
E OF FLO�I�A l.yc
STATE OF FLORIDA
COUNTY OF \�
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was ackno dged before me
this �� day of dl A r �� , 20A by
this day of � 20_ by
SaSe.p1n 'h•:t-d.
Name of per on making statement.
Name of perso/maki�g tement.
Personally Known OR Produced Identification
Personally KnoOR Produced Identification
Type of Identific tion
Type of Identifi
Produced � L' >D �
Produced
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(Signature of Notary P lic- Sta ���'=_—�" —'
MARIE GI`�4NS
(Sign ture of Notary Public -State of Florida )
pLANNA
°•••,, �s "ION#� �
Commission No.� •�
C
`'�*°�
EX RrOecembetGB7�aB
mission No. (Seal)
•" Publlc Undzrurrit�rs �
BondedThruNotaN
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