HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPUTED FOR APPLICATION TO BE ACCEPTED
Date:q — I —I - aC)aL Permit Number:
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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
PERMITTYPE: � Owl' Q-
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: L4 Q 3 (D0QQQ a n QQ Lot No. C�
Site Plan Name:----SLD'ro ri Block No.
Project Name: 5V)C�'Y-C')a i--C \i q o _
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
—Mechanical __.. Gas Tank _ Gas Piping Shutters
` Electric _ Plumbing Sprinklers u Generator
Total Sq. Ft of Construction: r
Cost of Construction: $ C2 j �
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
OWNER/LESSEE: I CONTRACTOR:
Name
Addr ss: etl
City: MEAC,
Zip Code: 3L-� q q Fax:
Phone No. - k CX~I�
E - M a 11:.5 1C,,j cDOk�k,rne1
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
—Windows/Doors
Roof Pitch
Building Height: ® _
Name: 4-4
Company: L a
Address:
City: t-* #�1e'(C^C _Stater
Zip Code: Fax--M46(�019 a
Phone No (0 "
E-Mail�l GU3 ci .C,a1`Y
State or County License o 6
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:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable t 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
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this (—day of�3J J20,-A,)- by
�0 - �z0Al':� Q.�k.
Name of person making statement.
ersRja I ly Mlowo_
Type of Identification
Produced
(Signature of Notary F
Commission Nocl�Q
REVIEWS
DATE
RECEIVED
COMPLETED
OR Produced Identification
- State of Florida) J
�a (Seal)
Notary Public Stale of Flo
Signature of Con
r/License Holder
STATE OF FLORIDA
COUNTY OF _ ST I_V G ( � TT
The forgoing instr ment� �w�as, acknowledged before me
this day of 52:�+ � 20al by
�t h-p- �- -Z' ca,
Name of person making statement.
OR Produced Identification
Type of Identification
Produced
\-ioW A(Ef,
(Signature of Notary Publi t
S)ate of Florida )
Commission NoGo(4 (Seal)
PLANS I VEG
REVIEW I RE
Notary
GG
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