HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE IIN•�'�!FO MUST BE/COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:� J Permit Number-.
UA
�i ; �1 e •
Building Permit AP r ation
Planning and DevelopmentServkes
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78 Commercial Residential _
PERM iT TYPE: '
-
Address:
'Oft-
1 ft - .. (-erc 7S
Property Tax ID #: 1,5C A 0 l O ( 9 � i o Lot No.Q-��,2
Site Plan Name: 1 ,� �� Block No. ov
Project Name:,
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: $ 3_? ,, S� G - Utilities: Sewer ,Septic Building Height:
Address:
City: VT WIM-C_ State:
Zip Code• 14 Dl5 1 Fax:
-
Phone No.. -%`� of 919 57L a (o
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name
Compa
��
City I- T r t z YC.-'C,. State:-, F(
Zip Code: .3A9S72 Fax-' �y6_19'D
Phone No nl' 6y 6
E-Mail 50 �',rCnt i� c CAtr
State or County License CA C, 6 A— i2io'J
f value of construction is $2560 or more, a RECORDED Notice of Commencement
It Value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Not;App, ICAbte'
;
MORTGAGE COMPANY: —Not Applicable
=Name:
Address:
Address:
City:
Zip: Phone,
State:
City: State:•
Zip: Phone:
FEE SIMPLE.TITLE HOLDER:
_ Not Applicable
B6146ING 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 Fnstallation 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 ermit holder to build the subject structure
which is In conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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
"WARNIMIG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMEmcErvi NT 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 RFkmF 60ennniiite. ,rnun PinTirr nvr rnmMi;wcFM�ur'9
Signature of Owner/ Lessee n ractor as gent for Owner
Signature of Copt , r/License Holder
STATE OF FLORIDA
COUNTY OF 511 L cfc 1-C,
STATE OF FLORIDA—
COUNTY OF . �.N i—C 0G,
The fo oing instrument was acknowledged before me
this , day of ITI A4 20�;,,;] by
The forgoing instrument was acknowledged before me
thts,� day of 2011- by
Name of person making statement.
Name of person making statement.
rsona y Know OR Produced Identification
y i tfation
Produced
ona y Know.,OR Produced Identification
Type of Identification
Produced
(Signature of Notary u lic- Mte of Flo a)
(Signature of Notary Publ(9 Stat of orida }
Commission No.GGT4 225 (Seal)
Commission No. (�GCkL4*cL' 5a ., (Seal)
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