HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: ,S Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
Address:
Property Tax ID#: 13ol 62CS o333 pool Lot No. )I c
Site Plan Name: A Block No. c7 9
Project Name: AgJii �
Additional work to be performed under this permit— check all that apply:
✓Mechanical Gas Tank _Gas Piping _fSih utters
Electric "Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $ -%R �oqc%- QO
Sq. Ft. of First Floor:
WiDdows/Doors
a� Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name wr, cet4 Mimm
Name:
Address:/ tzzo(4I A.\w" l ki
Company: r('JA
�ar 5{.xa[liaw ]drV7CQ5
City: Fa�ri YjQ'rca.- State:
ZipCode: ";L415 i Fax:
Phone No. 11Z .3-10 (0.55"7
Address: 1140 q7i AAW-
City: VkW &R. 1, State: TL
Zip Code: Fax:
Phone No �)1 ��3
E-Mail: -rY`aC2bt 04 I is Co&kcast- nvl
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail '10Sh ^
State or County License C RC I U, OR l $
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: Fy"k L-4OILe-
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 225 /a I Ave-
SE-
Address:
City: Van oew k
Zip-32tiGz Phonei12
State: L
321-95"
City: State:
Zip: Phone: ---
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign ffirof Owner/ Lessee/Contractor as Agent for Owner
Sl��g of'Contractor/ icense Holder
STATE OF FLO D 1
STATE OF FLORID
COUNTY OF LS) �7 �C ,
COUNTY OF
The for oing instrwas cknowledg efore me
thl u ent day of 20 by
nt ac
The for ing instrum wa knowledge efore me
thi day of ', 20by
ame of person making statement. /
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identific
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Type of Identifi
Produced
Produced
(Signature o
(Signature of Notary Public -State of Florida )
KAREN S. NIELSEN
Commission
-State of Florida y Public
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Commission N •oJ�•, KAREN S. (Slj`aI�SEN
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