HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O— Permit Number: �
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 TYPE: at,, .---. - . . r\
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
JI,HIV P
oil BY
s� �� ✓ % St. Lucie I
°9 62
Building Permit Applicatioi��°pd
Commercial Residential
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Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutter's
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: I?, Sq. Ft. of First Floor: _
Cost of C cYio_soeo r Utilities: _Sewer _Septic
Lot No.
Block No.
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
GONTRACCfOR:
N me_ /Y!%y t5ft eoa9'%
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Name: --
dress: :yG d0 &-IrW�4
012
Company:
y: 91- OG r r State:/
pCode: �y%�6 Fax,775— S� �a7�'
one No,7/� S'l/I/-2-2�n7
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Address:
City: State:_
Zip Code:
Phone No
Mail: Z Ni .�iL1�/ $ jai -
tin fee simple Title Holder on�ge
om the Owner listed above)
(if different
E-Mail
State or County License
IT value of construction is 92500 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.
S PPLE-MENTAL CO STRUCTION LIE INFORMA
ION:
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 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 N THF,JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LIENVER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Sgnaiur . r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF l C JFLORIDA
COUNTY OF
The f r oing instrument was a knowledged before me
The forgoing instrument was acknowledged before me
this �ay of �Qx 20A by
this day of 20_ by
L CQn I C.G.,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification L�
Personally Known OR Produced Identification
Type of Identifica i -}�
Type of Identification '
Produced T D L✓
Produced
(Signature of Notary Public- State of rida)
(Signature of Notary Public- State of Florida )
Commission No ""' (i€i«=N VAUGHN
commission No. (Seal)
[g.7.,%�. State of Florida -Notary Publi
• Commission # GG
REVIEWS
FRON
10 y Uo
Oct
mission Expires
to
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
RE IF
COUNTER
EVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z///19