HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPU
Date: '
FOR APPLICATION TO BE ACCEPTED . -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number. Lqo) 0 a/tn
F �
✓4412 0'/
Building Permit Application es /r,on419
c0411)ty ant
Commercial Residential
Address: 1,Z / JEA2 Ct7N CIA YL I- O1LT 1-��'ILc F t F L 3`I ly L
Property Tax ID #: ) n- 5a om- boo l9
Site Plan Name:
Project Name:
ETAILED DESGRIP
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Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
��otallSq. Ft Construct on- lI I13�.Ft .
Qo's f_Constructio $ 33200.0(3
_ Generator
Sq. Ft. of First Floor:
Lot No. /!�-
Block No.
Windows/Doors
�oof 3.Sx 12•P-P-itcbjr
0
Utilities: _Sewer _Septic Building Height:
OW ERMSSEE:
GONTRAC*TOR:
RaNAL-0 J 12Ei;,
L
Name:
Aame
ddress: )-L1 SEA CONCH
PL
Company:
city: 1:09, 911 ?-CF
ZipCode:3Li4$z Fax:
Phone No. T721-92-4 - 6A3
State: FL
5
Address: -
City: State:_
Zip Code: Fax: '" =
Phone No-._ _.._.,-... ;,.:.•:,..._
Mail: rwir2VYrioWX
j o-Pavl PQ`Moak Cbvh
`.1• -
dl in fee simple Title Holder on next pageJ(if different
from the Owner listed above)
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.
SUP EME'NTAL GONST ION IEN LAW I FO A ION.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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
is in Home bylaws
which conflict with any applicable Owners Association 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.
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 recording our'rNotnice of Commencement.
Dor
'Signature dy Owner/ s ee Contr ct r as Agent for Owner
-
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk- Lxt a`..e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this':),�dayof CGN 201g by
this _ day of .20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification V/
Personally Known OR Produced Identification
Type of Identification
Type of Identification
ProducedFL O I—
Produced
(Signature of Notary P lic- State'of Florida)
(Signature of Notary Public- State of Florida )
Commission No .":yrJ ., ELLEN VQk HN
Public
Commission No. (Seal) .
.FlarldatfJotary
Commission tl'6a 270079MI Com
.
2
REVIEWS
ISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
19
ev.