HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �A ` I 0Q I 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) 462-1S53 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: So `Ch v C � (f, C,
PROPOSED IMPROVEMENT LOCATION:
Address: _ J i I Urr -yek k (n cl l; O
Property Tax ID #: -3 " f U'A (-o 1 U l b
Site Plan Name: _ e
Project Name: C.-J"CC�- �t--o n ��
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Uo
l Ci (C--P—
Lot No.21
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: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
Name t—
Address-
City: vLtr=t State:
Zip Code: 3y��. Fax:
Phone Now—? i -
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: 1-.o DerA'
Company; G - 1Yler S ems
Address: <<a� sff-C:.�r 16') V11„ ,.,,.,.,...Lk --
City: ICT b e' C, , _ State: FL —
Zip Code: _ RC)% rl Fax-1_15)H U-Tn 3
Phone
4qN,`o ' GD`f`f ►D�
E-Maill� o ymn tJ R n-I by
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:Applicable
Name:
Address:
City: State:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
Not Applicable
In consideration of the granting of this requested permit, I do hereby agree that t 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 Contraetdr/License Holder
STATE OF FLORID COUNTY OF STATE OF FLORIDA � LU C-k `�
COUNTY OF � �--.V G -�
The forgoing instrument was acknowledged before me The forgoing instrum nt was acknowledged efore me
this day of em��{ , 20 by this day o ` t 2j by l
Name of person making statement. Name of person malting statement.
ally Kn OR Produced Identification
Type of Identification
Produced
{Signature of Notary Pu
Commission No
FRO
Personall K OR Produced Identification
Type of Identification
1 j � a
} (Signature of Notary P bli - State Florida }
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Commission No.C7: a+
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PLANS VEGETATION
REVIEW REVIEW
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