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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1,{�= Permit Number: R04-003) a1oo' gad SCANNED Wog bull W s St. Luce Coupt Val Application Building_ PermriAppllcation osia31" 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 PERMITTYPE: Address:_(pc�P jA)J YTVIV D�-t= IG4>�//CI • T-o"J Tity c� 1—L, �� �5" 7KoZ- Property Tax ID #: 1 ; tLTS IJAJ/L L/- / 33-6 -� DV® l ^ (c%i�� / 9 Lot No. Site Plan Namp- Rlnrk Nn Additional work to be performed under this permit —check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters Electric _ Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: ` ,p�!(� Sq. Ft. of First Floor: _ Cost of Construction: $ I Utilities: —Sewer —Septic Windows/Doors _ Roof Pitch Building Height: _ ONNEMMESSEE: CONTRACT©R; Name Y1 U ROJFSon Name: A Address: 1<00=A Company: City: �• Qt eic� State: Zip Code: 4 Fax: Phone No. Address: - City $tafe: Zip Code 1. ', u,. -: m j a F_ax _ Phone No n E-Mail: "VF rri5AJ, Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail State'or aunty License 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. I� r SUFFLEMENTALCONS ION LIEN LAW INFO MATION: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: 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 O H ITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOU LE OR A TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature f Owner/ Lessee/Con act r as Agent for Owner Signature of Contractor/License Holder STAT F FLORIDA STATE OF FLORIDA COU OF COUNTY OF ' The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_a by this _ day of 20_ by U r'10 Name of person making statement. Name of person making staterrient. Personally Known OR Produced Identification v Personally Known OR Produce dentification Type of Identification Produced Type of Identification Pro uced O (Signature of Notary Publi State of Florida ) Commission No. (Seal) S!Oatur& of Notary Public-Stat LASNpNNA1NGRAMMING Commission 01. tie."••: 111 SSIONNG�I� ! : '-V �I p��ba�L0.2022 REVIEWS T ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2/7/19