HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:/ —I 7-,Z/ Permit Number:
J.
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:
PROPOSED IMPROVEMENT LOCATION:
Address: :5:' 2 '
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
F
CONSTRUCTION INFORMATION:
S
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
']/
Y
Cost of Construction:/\ ,
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
4 Windows/Doors
_ Roof Pitch
Building Height: & 11
OWNER/LESSEE:
CONTRACTOR:
Name L A0 5
Name: J eoz J
Address: %S 3 L%2 k/f{1c/.' ,/� i! ,fir -
Company:,_ 3-1,q _t,,ylC-Je G� l,rz.�_= a!5 ahcf &: Ztr .
City: _141 r f State: r�
Zip Code: 34/98-7 Fax:
Phone No, 711 ' 1'1210 3v/V
E-Mail: f 'varc , 35'j CiY/rli� GGrY�
,
Address: 214
City: L>1e-3t Dfsl? �3e/lG/i State: Y/
Zip Code: Lfc1' 1 Fax: S4 %- Zo2—/y/�
Phone No SG / - 202_ — /L//..Z
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail cidjlglekyldej4d PJS cc Pf
State or County License S
it value or construction is SZ5Uo 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
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
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/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI A
STATE OF FLORID
COUNTY OF i A (0 �j�_IOQ' h
COUNTY OF
The forgoing instrument was acknowledged before me
this % day 6K-f177Per- 2.1
The forgoing instrument was acknowledged before me
of , 20 by
this 4 3 day of 20ZI by
Name of person makingstatement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known X' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
P
rr
Si ature o otar ubhcf tate of Florida
( g Y )
=
Si nature of otar Public t
( Y C�1d� )ion Erpir�sQ4 19 202°�
?
-
C� 3 fe�c t
Commission No.Commission
Cnm���is.,ior�rGUw9'iL'
of dea 1 hrou �h Can r ry
No.��C %�c`/�1-
,
} I Co, :riusinn Expir.s 04 it 2t ' ,
F; 1ok
r, at iC
REVIEWS
FRONT
-ZONING 7 -
'SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19