HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % ee i Permit Number: _QXn__�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300,Virginia Avenue,,•Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578 Commercial Residential Y
PERMIT:TYPE;,:
PROPOSED.INIPROVEIVI NT LOCATION:
Address:
Property Tax ID #: 3301 'V0 / C7L5?-d QzrO 1► Lot No. � Site. Plan_ Name; _'f_A_'OLL Gl��6l't - /4"45* 2 • Ldf�d AWO TiLA d1 �a�'�� Block No.
Project Name: _Ad h /!F4 At -"Aiw Z2f-C dA% S 44 C
PETAILED,DES.CRI;PTION OF WORK:
? o hjjtL. / O S{a VIEDV
'CONSTRUCTIO'N' MfORIVIATION:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank _XGas Piping Shutters Windows/Doors
Electric' — Plumbing _ Sprinklers _ Generator _ Roof Pitch
T, otal-5 . Ft of'Construction: S . Ft. of First Floor:
. q.. q
Cost. ofConst,nuction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE
CONTRACTOR:
Name 418a FL - /rf�,�..ti -•TkL U L�C'G
Address: —A a- d�y( f
City: � ,�% /� ��' ,�i d State: ��
Zip Code: 9//Z!/ Z Fax:
Phone No. Act (7«
E7IV1ail: iQTAAJSS&,) 4 ZrA0f[,c^t R `
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:r_Ar_f6AJAjt l �e.•l
Company: % 4AS
Address: 213G X.�wd
�R
City:
Zip Code: z Fax:
Phone No 770. • R-20 - • 6
: State
r2
E-Mail Q.CA,;✓
Cd . L�
State or County License /a 34
0(
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.
SUPPLEMENTAL CONSTRUCTION LIEN
'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.:L,ucie 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 ii c6rdance�wiitk. 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,
acyessory.strUctdres swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
i"WARNING TO','OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 'IN YOUR PAYING
TWICE oFOR 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
WITH YOUR LENDS OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMME EMENT."A,
.1 AdA k�7 P
LAW INFORMATION:
DESIGNER/ENGINEER:
Name::;
Address:—
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:..
City:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Zip: • Phone:
Zip: Phone:
Signa re_of rLv er Lessee/Contractor as Agent for Owner
i re of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY.OF
COUNTY OF
j The. -forgoing instr ent was acknowledged before me
The for oing ins tr nt was acknowledged before me
this .day o 2t� by
this � day of 2� by
.Nam'e o person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
r
(Signature of Not y Public- State of Florida
(Signature of Nota ublic- State of Florida )
Commission No. ,.�-..
��,..•,..��;, UDREYB. HREY 1
Commission
,o{,s',�,•ys4c;- { B.NUMPH EY
MY COMMISSION # GG 300817
MY COMMISSION # GG 300817
EXPIRES:
March 6, 2023
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