HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1Q- C;tsY C-40a Permit Number:
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Me -is
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION: �1
Address: e� (� r'' (,,(i°
Property Tax ID #: 5-3c) v t �q 0 d (2)
Site Plan Name: y-V
Project Name:
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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:
Cost of Construction: $�1
OWNERAESSEE:
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Name
Address: 5 1 ILii' K)ca r,' {kc-�
City: ST L r-k e. W -eS'� Stater L
Zip Code: _'S9 9 T Fax•
Phone No.
E-Ma i I:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: k5c, be
Company:: air-,
City: F7- 1
Zip Code:
Phone No 1
E-Mail i /
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.
Building Height:
n,- C
ne S Y S
State:-[-
_
,, a(6'
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
—Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
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 IMPROVEMENTS 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
r WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee n ractor as gent for Owner
Signature of Cant' r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 7 (,uC(-r-, 1COUNTYOF ST L L)r- e�
The for oing instrument was acknowledged before me
thisday of 2a,?JL b
q� fir+ z� I (_, c l
Name of person making statement.
(frersonally OR Produced Identification
e ofddenWcation
Produced
(Signature of Notary Pu lic- tate of Florida )
vd
Commission Nor��.�4Y�5;.. (Seal)
REVIEWS FRO
COUM
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this 2�5ay of T! 26,QJ by
9(11 �e Z rrA � � a(- K
Name of person making statement.
OR Produced identification
TV-PerMdentittcaLion
Produced
,4
K VJ C
(Signature of Notary P(uubl - Ste of orida )
Commission Nf>� -�SI
PLANS VEGETATION
REVIEW REVIEW
State d Flonds