HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR, APPLICATION TO BE ACCEPTED
Date: 2 CQ"c;� Permit Number:
W
Cou r
F L. n i
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial
PERMIT TYPE: So i C.,U s
PROPOSED IMPROVEMENT LOCATION: G
Address:
Property Tax ID #:
Site Plan Name:
Project Name: g a 1
cal L-t 1) CAH(J'- O U01-
I DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Z.
Residential �I
Lot No. .3 I
Block No.
Additional work to be performed under this permit —check all that apply:
—Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors
XElectric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3-� L—) O�
— Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name. l...i �GM5,Z.
Address:
City: State: F I-
Zip Code: -JM C15 I Fax:
Phone No. —i �l E/0 �srS g:L...
E-Ma i I:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
i
J
Name: e �- V - c-k
Company: G - fle y-2 S e
Address: 160 cv w '
City: FT l e, rr-e _ State:-F—L-
Zip Code: 3f "F, Q Fax.1-a k.;n
Phone No - T-?."I (v
E-Mail
State or County License v (
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. J
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:
Zip: Phone
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,
State
Not Applicable
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."
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lSignature of Owner/ Lessee n ractar as gent for Owner Signature of Cont r/License holder
STATE OF FLORID I STATE OF FLORIDA -
COUNTYOF T - �JC _ COUNTY OF ST � U C.} -c
The forgoing instrument was a knowledged before me
this day of e , . 20 i_1 by
P be r� Z+-y\ t ke_ iL
Name of person making statement.
rsonally K�' OR Produced Identification
ae o I —identification
Produced
r _AV �.�1,
(Signature of Notary P bi c- State of Florida
Commission No.&lsgLl S u
ot� ublic State of Florida
Kimb" Large
REVIEWS FRONT
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrume t was acknowledged before me
this day of pqf 2 0aj, by
Name of person making statement.
Personally Kna OR Produced Identification
rypE—offffentification
Produced
(Signature of NotaryMlic- State of Florida ) )`_
mmission /1al
Aar' N2 Notary Pub#c State c
oPLAN5 J VEGETATION I SEA
REVIEW REVIEW RF