HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA,4LE 1 0 LIST BE COMPLETEDFOR APPLICATION T0BEACCEPTED .
Date:PennitNumbeOka
Building
Permit J� U^
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Planning and Development Services
Building and Code Regulation Division ^ ~''"'^u/`/9
23OOVirginia Avenue, Fort Pierce B3498Z
Phone: (77Z)462'ISS3 Fax: (77%)46Z-lS7O Commercial Re����O�i�����������--�-����
PERMITTYPE: A(90_� aaq�
Address:
Property
Site Plan Name: Block No.
Project Name: '
Additional work tobeperformed underthbpemoit—oheckaUthatappky:
—Mechanical __GasTank Gas Piping __Shutters
Electric __Plumbing Sprinklers __Generator
Total
Cost of Construction: $
Sq. Ft. of First Floor:
___Windows/Doors
/`�SKoofW/aPitch
Utilities: —Sewer —Septic Building Height:
WON' ITIRTAN11TO
Name we
WName:
A+
J State:
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Fill in fee simple Titi Ho'Ider on next page ( if different
from the Owner listed above)
E-Mail !C� ILI An 6-TA
no\r_ am,
State'llor County License 6W
Ifvalue ofconstruction is$2500o,more, aRECORDED Notice ofCommencement is required.
Ifvalue nfMVAC is $7,500ormore, aRECORDED Notice ofCommencement is-' uired.
S PPLEME TA CONST UCTIQ LIEN LAW INF
R A Q
DESIGNER/EN
Name.
= " ' Not Applicable
MORTGAGE COMPA _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: P e:
FEE SIMPLE TITLE 7PLDR: _ Not Applicable
Name: Al
BONDING COMPA Y: Not Applicable
Name:
Address:
Address:
City: IV I �kCity:
Zip: h ne:
Zip: o e:
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
WITU'1 bJUR LENDER OR AN ATTORNEY BEFORE RECORDIRq-YQUR NOTICE OF COMMENCEMENT."
Al
Sig a re o caner/ Lessee/ ontractor as Agent for Owner
S a re of Contractor/License Holder
STATE OF FLORID/C
I
STATE OF
St. Lu
COUNTY OF •,fi"
COUNTY OFORIDA�%
The for oing instrunAent was acknowledged before me
this ay of i 201Q by
The for oing instru ent wa acknowledged before me
this lay of /Qi �. 20,gZo by
Name of person making statement.
Name of person making statement. /
Personally Known OR Produced Identification _J/
Personally Known OR Produced Identification Y
Type of Identification ;� I i
Produced F/OkeiclA DVPIU'P.n'S (.-i(�{ilse- -
Type of Iden if' ation J/
Prod ced dRI CrAJ ) 'yws Lt Ce4ije,
(Signature of of ry Public- State of Florida r GLENDA J.
d+e of Notary Public- State of Florida )
% NOTARY PL
No �g "i'STATE
BLIC' ! p
No. � I 0 (SeNOTComm#
OF
VIRGLENCommission
Lission
GG156884o
STATE
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGRPRre
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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