HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J0al_ Permit Number:
- J
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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 �I
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: DO Rasn r-r-c,
Property Tax ID#: nn34 oa (0(o o( 5- 006 S Lot No. la
Site Plan Name: ,�`` be-�-+ Sn i a -e y-- Block No.
Project Name: QbV ►-T Sn t �.
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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: $ 541 q 5 Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name o Name: G 1
Address: 5 C3 , �tra'+i Company.J4I tl e e
City:.-_F-F Pi c rC - State: EL Address: Ck\
Zip Code: S Ll I T-DL- Fax: City: FT Stater
Phone No. 55( zip Code:�2` �$a Fax:
E-Mail: +(ll 0.� CC' Phone No._..�44� �oC( (p�3
Fill in fee simple Title Holder on next page(if different E-Mail 0�jC�l�� V,r(ye'r a"A 0�)9 y'%M 1I,t' —
from the Owner listed above] State or County License C' V cjj
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 LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable j
Name: Name:
Add ress: Address:
City: State: City: State:
Zip: Phone Zip: Phone: I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING 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 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT,"
Signature of Owner/Lessee n ractor as gent for Owner Signature of Cont r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S� L o c, COUNTY OF C_
The fo going instrument was a knowledged before me The forgoing ins meet was acknowledged before me
this " day of 05 20spj. by this q day of_\-Jo o,0 201)!J by
Name of person making statement. Name of person making statement.
rsonally Kn n OR Produced Identification ersonally Kn OR Produced identification
Type o Identifica#ion Type o Identification
Produced Produced
��JL
(Signature of Notar Pu Gc-State of Floricla,10 gnature of Notary PuLbblli -S tea orida}
Commission No. - F) (Sear ! Commission No. �!> l (Seal)
a
y*• Nota7Public Slate of Florida mil_ -
tmberSy Lafge - �.+ Notary Public State of F rida
REVIEWS �2 Zg 90ftRV OR PLANS TIK Wberl 5j4JUR��E ANGROVE
C E I f I REVIEW I My ;ssHF�gFlA�7s2 REVIEW
DATE
RECEIVED 1
DATE - ~
COMPLETED 1
ev. 277/19