HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED QQ
Date: 'LJ IS) / °j Permit Number: ov.
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Building Permit Application ",e'6111M
Planning and Development Services Department
Building and Code Regulation Division penntttlng Pa
9 C � � 5'� St. Wele County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: /y� SCANNEL
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Address: 60 6c7 SZP,JH P'trJG- 7'2L. 1,::7- '(Ni 14-2`,-.- rZ- 3frys"2
Property Tax ID#: Ly %k- Z /3- 00 Z 0 - 0 0 Lot No.
Site Plan Name: S L/4S/f al.-c- r/LL— Block No.
Project Name:
PCA .gate- i=,asrr-dD '>-1r- ,%za'J,.1 uj rA I) .t 3�
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Additional work to be performed under this permit- check all that apply:
_Mechanical
_ Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 70.C5. '
_Gas Piping _Shutters Windows/Doors'
_Sprinklers _Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities:,- ,.,Sewer _Septic 1 Building Height:
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Name�rj2y} [Lrfnkrfr,r/fsr�/L
Name:`<,, QS'°.n S
Address:__ 50 G S P aiA r%r-lr= T2t_
Company:.
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City: FT- f�•L�c rz State: F�
Address: �i
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City:
Stater
Zip Code;-3iSsl -fax :
Phone NohF/;-. 7?S 9:Z4a
Zi Code:
P 3y98�l.,,-' Fax:
Phone No .;? ' -701
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Fill in fee simple Title Holder on-neitt-page ( if different
E-Mail C ImrrG i/E, P
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State or County License l^ 1 a (o
from the Owner listed above)
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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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City: 4 = 5•
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Applicable
Name:,
_
Name:
_Not
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I. certify tha;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 worker-Tecording your Notice of Commencement. I
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Si at.wner/ Lessee/Contractor as Agent for Owner
S r ractor/License Holder
STA OF FLORID QQ
SATE OF FLORIDA
COUNTY OF 5-1- Luc,u
C UNTY OF F �Q
The forgoing instr nt wd�¢s acknowledged before me
this P' day /cln 20 by
The forgoing instrument was acknowledge before me
day (I by
of a
this of ^ 20
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Name of pPJson niaking st ement.
Name Iperson making statement.
Personally Known OR Produced Identification
ersonally Known OR Produced Identification
Type of Identification
Produced fA I.lc�ns¢ IJe. I—II`I3-]dl GOB c}s°
a of Identification
oPr uced
(SignathrEkof Notary Public- State of9 ri a 4-1
(§4DAure of Notary Public- St of Florida I
Commission No. FF90H$85I)�
Commission No.
L/tSHAHNAINGRAMRAHtdING
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