HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAB E I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2U Permit Number: aC'�a��d-D, D
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Building Permit Application
a
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:
C
1PIR-011109.0D IMPR01lEM'FNT LOCATION:
-� S
Address: \ \ 6
Dy
Property Tax ID #: qc .' v —8 —00O'� L Lot No.
Site Plan Name: C .c2r-1 .90.\ Block No.
Project Name:
DET I .ED DENS ■Ri TdQ��.O��F WORT
a ,
CONSTRUCTIa INF4R ATION:
Additional work to be performed under this permit —check all that apply:,
_Mechanical ` ' _ Gas Tank''"I '° Gas'Piping Shutters'`- Windows/Doors
_ . _
_ Electric _ Plumbing . _'Sprinklers _ Generator _ Roof ' Pitcli
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ '452b/9 ° •0� Utilities: —Sewer _Septic Building Height:
OWNS %LE�SSRE:
CaNTRACTOR:
Name �/ill�j� I ,% !J/7r�" '
Name: �% -t
Address: 7D(I,-.t�c�tJ7 r ,SH.o� 17.
Company...S- tlC,Tll Cdd
City: %U�Ii�Tik /Ll `el` :;rdU'� r�,. ?State: /v�
Address. ^
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City: ��'C%�� Xi��, s '� 4� .< State: �Z
p / 3 � Jam. +� r •Fax �^ Y �'
ZI Code;*` ?„/
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Phone No'.--.<• r �w , �.� , r ,. a
`M - 1P.',`: "•I' 3 fit' es
Zip4ode:•,
E-Mail:
Phone No Ay
E-Mail W QD/' Cad''?
Fill in fee simple Title Holder on next page'(if different
State or County License GGG 04,1033
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER.
Name:.$PPiSCrU9nL 45,q�iJ�CR/,tiG
Address:-7J7:. Z044 4
_ Not Applicable
6Wa kC,
MORTGAGE COMPANY: _ NotApplicable
ime:
Address:
City: m Se
Zip: 33ypR_.`' Phone rw.
State.:
/Ud J
City: State:
Zip: Phone:
FEE SIMPLE:TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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-herebyagree-that l4ill 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 FLORIDA
STATE OF FLORIDA
COUNTY OF S% L dCi.(
COUNTY OF ST 411ci,P
The forgo' g instrument was acknowledged before me
The fork'ng instrument was acknowledged before me
this /5 day of &Mt4 20_.0 by
this day of /%w 20_j by
LeS
Name of person making'statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known !/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature o 4
(Signature of Notary Public- t t f I r
Commission No. ` Notary PUqt�.c Stti�le of Florlde
hannonll knell
�t ` Notary Public State of Florida ,
Commission o� Shannon O'Donnell((SE
248323 �'
My Comrrilssion'GG 248323.'�
Expires 08/13f2022-
My omm srifon GG
Expires 0811312022
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