HomeMy WebLinkAboutBUILDING PERMIT APPLICATION`' ,e P 154`r e
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 Cal Permit Number:
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: R re 0,1 q r m
PROPOSEO I'MPROVEIVIENT LOCATION: 1 1
Address: �7-. /V ncDk" Wf aliwn u 14J- A. I�i�I A-k Q4c�)l n,Yn
Property Tax ID #: l aR --gb'� — C p= — Qp�)- 9 Lot No.
Site Plan Name: Block No.
Project Name: GEAti,<) ms i—E
DEt4lLED'OESCRIPTION OF'WORK:'
NSTRUCTlbN I-NFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric v� Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ S9 I qOO • M Utilities: —Sewer —Septic Building Height:
bW,N;ER/LESSEE:
CONTRACTOR:
Name QancL fie- el� �4-k "�1
ame: lS- Fi1-e-+ "secU,i`-k
-
Address: - s� r Z
G�iGC rs c —, o cap
City: Veow (mac,. State: FL.
Zip Code: 3a q6 a Fax:
Phone No.
mpany: LUi iam QV\ rew
Address:
co
City: State: F (—
Zip Code: _7��q 6c;L Fax-']7A_ 194_a.1N0 %
Phone No—11a.—IR -i. aaab
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail X-C M
State or County License F—F — Wo l 12 7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
1
a.<�biT.''��r.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone,
State:
City: State:
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' T® RECORD A NOTICE OF COMMENCEMENT MAY RESULT 1N 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
I WITH Y0110 ENDS ATTORNEY AN ATORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
SEgnatur o Owner/ Lessee/Contr or as Agent for Owner
Signature of Contractor/License Holder
STATE OF -FLORIDA e— ,� ,' pp�
STATE OF FLORIDA ,
I
:2
COUNTY OF T* . Ly(�'
COUNTY OF . a
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
o .
this day of 20 by
this .day of 20�Oby
- `
► t,VIP, S
Name of erson making statement.
Name of person maki
Known OR Produced Identification
7stement:Personally
Personally KnownOR Produced Identification
Type of Identification
Type of Identification
V511.
Produced
Produced
�lni
ITHWINC
qv. sue`
er,••;
5i attire of N ry Public- State of Flori � }�. o : Notary Publi
ublic-State of Florida )
I �� ; • Cohn issi �*, My Cornet. Ex(Seal)
Commission No. a{7��.
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Bondec: a�gh
REVIEWS
FRONT
ZONING
SUPERVISOR
-PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2,/71T9