HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
APPLICATION TO BE ACCEPTED
Date:
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: 1 09— Moi
Building Permit Application %,9 0 elvWAVNE®
Pe St. rrit/ eoepan Cie County
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Commercial Residential �i,
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Site Plan Name: Otte n K e�So(is Coepc r-a+Ve_
Project Name:
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
_ Gas Piping
_ Sprinklers
Lot No. 12S3 _
Block No.
_Shutters —Windows/Doors
Generator Roof Pitch
Construction: C8 Sq. Ft. of First Floor: $4 s4'
uction:$ 3?4Gz,Y8 Utilities: _Sewer _Septic Building Height:' IV_
OWNER/LESSEE:
CONTRACTOR -
Name kA-4, `5P A,
Name:
Address:P)
Company:
City: I (�i�i , n c�,� 15)� State:
Zip Code: '3LN+1 Fax:
Phone No. (.67- q1-G4-444
Address:
City: State:_
Zip Code: Fax:
Phone No
e-VA,
1JE
Fill in fee simple Title Holder on next page ( 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.
SUPPLE,IVIENTALCONSTRUCTlOIV:LIENLAW:INFORMATlO
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 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 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 recordine vour Notice of Commencement.
/Lr -�
_Sig u :of;- w,ne, , essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
COUNTY S `I LU cid,
STATE OF FLORIDA
OF
COUNTY OF
The folgaing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this: ddaayyof/ —e2 20Wby
this day of .20_ by
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Name of person maMing statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary Pu - State
a of Notary Public- State of Florida )
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Commission No. ==° )Sco of Florida -No
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