HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED I-_ APPLICATION TO BE ACCEPTED (-
Date: (-) — U ✓( VI -Permit-Number:-
._._ Building Permit Application s
Planning and Development Services CANNED
Building and Code Regulation Division �f Lucie Y
2300 Virginia Avenue, Fort Pierce FL 34982 County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential (z
PERMIT TYPE:
PROPOSED INPROVEMENT LOCATION; •,
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
a-515-
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Constrt�>n: $JV e (` a
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
,OWNER/LESSEE:
CONTRACTOR:
Name SL FI= /h ,ifyc.
Name:
Address: �2 4Z L i .t✓o d 4
Company:
City: '5 e State:F�
Zip Code:-3 ct �� Fax:
Phone No. i -,> z
Address: '•
City: State:_
Zip Code: Fax:.
Phone No __....:_... _,.... __._-- ..-.
E-Mail: /9.'I/e-' 9� f5y-�) r iJiayslc •
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.
SUPP{ EI1lIENTALgC
RUCTION lJEW AW INFOFtMAT
A. ,
DESIGNER/ENGINEER
Name:
_ Not Applicable
PP
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 recordins vour Notice of Commencement.
A
SignatuOwner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA Lj
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledgPd,before me
The forgoing instrument was acknowledged before me
this Sz day of ,;pgr;5. .2 Ic1 by
1e & mal 1, TTT
this _ day of 20_ by
Name of pers n making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Prod uced,ldentification
Type of Identification
Produce L i
Type of Identification
Produced
(Signature of Notary
(Signature of Notary Public- State of Florida )
..., ELLEN VAUGHN
Commission No.
=°+° �- State of 'ga-Notary Public
cc)MMI a o M GG
Commission No. (Seal)
2-10079
My OMMI11eloti Exnlres
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev.9/26/18