HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "� "1 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
PERMIT TYPE;
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PROPOSED IMPROVEMENT LOCATION:
Address: `i 50 �(f q I' f '� I CrC — 3q "
Property TaxID#i: l �u G 0Ua 000Qd Lot No.
Site Plan Name: c q Block No. l u
Project Name: N � C-
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank —Gas Piping Shutters _ Windows/Doors
'Plectric _ Plumbing Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $, l Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR., 1
Name t c.:
Name: � � �`-��
c- C
Address: cU c'.
City:. _-E-F 21 c rc- C _ Stater
Zip Code:-5L4C)j S Fax:
Company: AC~ — c� L C' 1`
Address: c i
City: rT I c�rc State: �-
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Phone No. '�� r�� �} . 1c�5�
Zip Code: Fax~1-1 Q q ( 'i 9 �~l
E-Mail:
Phone No (p
E-Mail cCO L' c, l +C�•:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
State or County License CNYU05 r i 31%
i
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:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: Not Applicable
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conKict with any applicable Horne 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 .SOB 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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Signature of Owner/ LesseetGQnyractoras gent for Owner 'Signature of Cont r/License Holder
STATE OF FLORIDA
COUNTYOF - T �,UC
The forgoing instrument was acknowledged before me
this ;�Y— day of fCQ xi jt t� . 2Qi4 by
�c>0 -e` a,
Name of person making statement.
rsonally Known � OR Produced identification
Produced
Gl� \— c
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Signature of Notary b c- State of Florida I
Commission Nd�otG ya (seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
STATE OF FLORIDA
COUNTY OF >T �_V C l
The for oing instrume t was acknowledged before me
this day of -__ F'_ 20 y
( , tr_c�_Mc� 'e
Name of person making statement.
sonally Knowry OR Produced Identification
Produced
Ly� ��
(Signature of Notary Pu
Commission
:71lkAN� VEGETATION
REVIE REVIEW
Notary Public State of