HomeMy WebLinkAboutappAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED- 0�a
Date: 5 L Permit Number: 1 1
r ,,;��, RECEIVED
Building Permit Application
?Op9-- JUL 15
fining and Development Services
ding and Code Regulation Division La.-_L--s�uui°�t- -_- , i'ermitting
0 Virginia Avenue, Fort Pierce FL 34982 Residential
me: (772) 462-1553 Fax: (772) 462-1578 Commercial
RMIT TYPE: O _ , _. 1".
'PROPOSED IMPROVEMENT LOCATION:
caress: 1 �
Lot No.
roperty Tax ID #: �J22 `'✓0� aL
Block No.
ite Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:,
Additional work to be performed under this permit -check all that apply:
_Mechanical _ G s Tank _ Gas Piping —Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: -1,0b Sq. Ft. of First Floor: _
oL-1
Cost of Construction: $ & ODO Utilities: _Sewer _Septic
'OWNER/LESSEE:
Address:l
City: ��� State:
Zip Code: �?*q8j(y Fax:
Phone No. (ot ;0- A3 . 51�J ,
E-Mail: -AQ6 XrZSC' C•1""'
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Windows/Doors
— Roof Pitch
( �51
Building Height:
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Address:
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.l 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 bylaws
rules, 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.
(consideration
In 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 LEN R OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Pt
Signature o(Owner/ Lessee ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI
�4 Lo
STATE OF FLORIDA
COUNTY OF S . '
COUNTY OF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this lb day of V \y 20 \ by
this day of 20_ by
I
%) -z
Name of person making statement.
i
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L-
Produced
-ct�er��(Signature
of of Notary M c o Flori cdrun�gsioNc��e,ao2o
'(Signature of Notary Public -State of Florida )
tV
Commission No.CG `� ' '�SD�aryPub��.'
Commission No. (Seal)
Bopae
I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
:Fe—v.