HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -&- rl -' G� Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenge, Fort Pierre FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: —)q0'i A, hl1 S f, i-) c i2
Property Tax ID #: / Y—) I bo CA,
Site Plan Name: —SCSIn
Project Name: S« -�
DETAILED DESCRIPTION OF WORK:
LW STRUCi�ON INFORMATION:
oaoL
rc_' c FL
Additional work to be performed under this permit -check all that apply:
—Mechanical `Gas Tank _ Gas Piping Shutters
— Electric Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ A a`{� _
OWNER/LESSEE:
Name --SA, n S, .SV
Address:--1g0y J�kb, &e
City: _ PI State:
Zip Code:`' a] Fax:
Phone No. 1 �
i_-Mail:
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
Lot No. I a-
Block No,
— Windows/Doors
_ Roof Pitch
CONTRACTOR:
Name: c c Lt
Company:
Address: kQ 7
City El V, f-r C
Zip Code: C( C)!K
Phone No
E-Mail c'
State or County License_13
If value of construction Is $2500 or Mom, a RECORDED Notice of Commencement Is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
Building Height:
c
c rr7�s
Stater
Fax: �I61ck
SUPPLEMENTAL. CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _-__Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER; Not Applicable
Name:
MORTGAGE COMPANY: , Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _ _Not Applicable j
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 Coun-y 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 N YOUR PAYING
TWICE FOR IIMPROyEMENTS 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
WUN YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee jn�ractar ent for Owner Signature of Cont r/License Holder
STATE
COUNTY OF FLORIDA ST LUGS -�, STATE OF FLORIDA
COUNTY OF 5T_ -` C,I
The forgoing instrument was acknowledged before me
this -L!iL day of 264;L�-J by
Name of person making statement.
PersonaIIVr Known OR Produced Identification
Type of Identification
Produced
{signature of Notary Pu lic- tate of Florida j
Commission No. GG7,g4 ,� (Seal)
REVIEWS FRONT
COt1NTER
DATE
RECEIVED
DATE --
COMPLETED
I
The forgoing instrument was acknowlecled before me
this L dayof_,c,ne -20b
Name of person making statement.
Penal y Known OR Produced Identification
Type of Identification
Produced
{Signature of Notary Public -;Ste e of Fionda)
Commission No. q al (Seal)
VEGETATION E Miy
REVIEW E Ert
stale Of