HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO'BE ACCEPTED c'
Date: � 1 Permit Number: I g0o2' O 75�
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 TYPEr4Z� -ROOF
MENT LOCATI
Address:
SCANNED
Building Permit Application St BY
Lucie County
Commercial Residential X
r- sT Wcic
Property Tax IDtf: 3 Lfj 1-53D-'Da,S9 —bDc> 3 Lot No.3�
Site Plan Name: Block No.4
Project Name:
DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator X Roof 4— Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: C%d
zq0
Cost of Construction: $ �8. '55p
Utilities: X Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name IIiAo� Q
1+11,1 QS
Name: / b F5
Add ss: %I
Company. 1 ino D[rFS a UG
City f _ 5{—LUQ State: L
Zip Code: lyl 53 Fax:
Phone No.
Address: S kl!2Qs�
City: IN Qf La
Zip Code:3Wl L%� Fax:
Phone No %3
State: ��—
E-Mail:
Fill in fee simple Title Holder -on -next page ( if different
from the Owner listed above)
E-Mail 1��6e
State or County License ree
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
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
commencingwork or recordin our Notice of Commencement.
Signature of Owner essee Con nt for Owner
Signature of Contractor/License Holder
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STATE OF ORIDA S I l�GtE�_
STATE OF ORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge before me
The forgoin instrument was acknowledged before me
-T/rA�
thi{��day of TlAt�/ 20_qby
this day of 20� by
LV(S QV�Aro(NCS
uls U/AldsvEs
Name of person tnaking statement.
Name of person m king statement.
Personally Know---J OR Produced Identification
Personally Know OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(' ture of Nota
(Si ature of NotaW�-
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Commission No. +R Desiree FII
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Commission No.mmiy�q�p�Zao688
y Commis on 0 240eeG Expires 071=022 '
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Rev.9/2b/113