HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3O Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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unenaioriv,
o s AON
Building Permit ApplicatI 2'd
Commercial Residential
PERMITTYPE: Vnc�ra\ Cot ot.r �-
1 b o3 s, 1"vi� 4F 4 i
m5m 35-;2--503-
-0
Lot
2-
Site Plan Name: BY Block No.-3—
Project Name: St Lucie Ounty
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters•
_ Electric _ PlumbingSprinklers
_
IL IWV' i i-eifnt-_anstri rtian- -1 /d 0
_ Generator
Sq. Ft. of First Floor:
—Wind okvs/Doors-> .
y" ROof1 " :PjtgN
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
ame , •ftl AWd)vame:
Address:
Company: -
City: I F P i e✓ r
Zip Code: W � Z Fax:
Phone No. % )—
Statef
Address: .. .
City: 'State:_
Zip Code:
hone No
E-Mail:,` J 101 3 N? 1 L( C-&a i L , COl
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTA C0 STRUCfION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the Sabrk 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 p"
which is in conflict with any applicable Home Owners Association rules, bylaws or ano 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
kll\ O---,
Signature Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S*. Lo c tk COUNTY OF
The forgoing instrument was acknowledgecLbefore me The forgoing instrume was acknowledged before me
this 3 d day of N 20 tVV by this day of 20_ by
�N I%t-N\CA 5",*'*1)
Name o person making statement. Name of
Personally Known OR Produced Identification
Type of Identification
Produced_ V I- O L—
Commission
REVIEWS
1:1X111Iglt/Ar7
COMPLETED
MMiSS1GNq 00022 29
0
RES: DQO"P""
6"dWIMNOWY Publfe
making statement.
Person3plfy Known OR Produced Identification
Type 9f Identification
(Signature of Notary Public -State of Florida )
Commission No. (Seal)
COUONT I ZONINGNTER REVIEW I S REVIEWO'I REVIEW I V EVI WON I S EV EWLE I M REVIEGETATIEATURTANGEW