HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date:3�S� PermitNumber:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Ap
Commercial
b
ion' 13 2819
ST.
Residential
PERMIT TYPE: G � rk
o,,o
BY
PROPOSED IMPROUEMEN
LOCATION;IM
aNyAl
Address:
Property Tax ID#: 83�3"1�� OaQ�-bOd-� Lot No.
Site Plan Name:
Project Name: L`l6i ,?A"cafZ t u sua eU
Additional work to be performed under this permit -check all that apply:
_Mec nical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ / /. 000. ^ `�
Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Block No.
Windows/Doors
Roof
Building Height:
Pitch
OWNER/LESSEE;
CONTRACTOR:
Name C,
Name: r^pc 2
(>�trltLo
LLB
Address: (o1(a3 <41+ 4 S
Company:
City: P!r . jO.r4t r ( State: K I
Zip Code: 3 f4 2/< Fax:
Phone No. �7!)^a- - 6/4 4 - ke(oa-
Address:/ S�%S�
� ���
�0 A
City: Vim-y
Zip Code: 32,j6 Ca Fax:
Phone No 7? 57a JL�661L6�
State: rc,
E-Mail: cY �»7� 31- Gcr�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Srr'C-(V— do c.2-YM�
State or County License t� aG
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 ENTAL DONS ON L EN N INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 01 NER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE IFORAMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEME T BE RECORDED AND
POSTED,P THE JOB SITE 8 O THE FIRST INSPECTION. IF YOU 1 END T OBTAIN NANCING, CONSULT
WITH R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NO � [E OF [ MMEN[E NT 1
Agent for Owner I Signature of Contractor/License
STATE OF FLORIV STATE OF FLORIDA
COUNTY OF .5 - ".. 'C COUNTY OF tOr • L%��
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \_�?L day of IIINO� ( 20N'�_ by this Naday of NNVq ( 20A by
6-`c�_')_4N CoJC-� V\ S'taAevN C('Nnk:t
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identifi a,3
Produced ' �- i� L-
(Signature of Notary Pbblic- State
Commission No.
REVIEWS
RECEIVED
DATE
DNA„�N g GG 071023 1
CpMId eJ,per 16'2')1'
OPSE PubimUs
�
IRES;, rde�`71v'
Personally Known OR Produced Identification
Type of Identification
Produced �L L ld t_
(Signature
Commission
16.
ZONING PLANSREVIEW I., REVIEWOR I REVIEW I VREV EWON I S REV EWLE RANGOVE