HomeMy WebLinkAboutBUILDING PRTMIT APPLICATIONAIIAPPLirik BLE'INFO MUST BE'&�, ,i.�1TED FOR APPLICATION TO BE ACCEPTI-' {
1
Date: Permit Number:
AIN 1 I
_ �_ 11 1
_- Builg`Permit Application
Planning and Development Services
Building;andtEodeRegulatioryDivisfap St� ey'V�Q
2300 Virginia Avenue, Fort Pierce FL 34982 C
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial `Residential 04
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PERMITTYPE:
I PROPOSED INPROVEMENT-LOCATION:._
Address: ) ZGZ
Property Tax ID #: 47�o O %%
Site Plan Name:
Project Name:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
i
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: U' Sq. Ft. of First Floor: /v
Cost of Construction: $ : O O, o (0 Utilities: —Sewer _Septic Building Height:
OWNERJIESSEE.,^'
q ;.;
CONTRRACTO9:
Name
Name: D?Jfiflji
Address:
Company:
City:State:
Zip Code: �. 9y Fax:
Phone No. % - 0-:�76 --57
Address:
City: State:_
Zip Code: Fax:
Phone No "- "
E-Mail: Ar (� P
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County 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.
S<FPLEMENiALGONST U„ i N UELAW INgFQtMATIQ,Nkk
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DESIGNER/ENGINEER:
Name*
_ Not Applicable
^
MORTGAGE COMPANY:
Name:
_ Not Applicable
Addre59: d , ' t
—, r `
Address:
City: I! r
Zip: ` Phone
; Sta4�:
` J
-City:
:Zip: - Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 jobsite
before.the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work o�`recording your Notice of Commencement.
511
as Agent for Owner
STATE OF FLORIDA I k, ri
COUNTY OF ` `�1
The for oing instfumen w acknowledged before me
this rz' , day of i�n ' 20V by
a �Q on M�
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced(
Commission No.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
of Notary
•'
_
%��
ELLEN V
�'; State of Fl0r(da-
_ Commission #
M Commis i
U I{['
dtXfay ullif
G 270079
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REVIEW I REVIEW I REVIEW
i No.
VEGETATION
REVIEW
- State of Florida )
(Seal)
SEATURTLE I MANGROVE
REVIEW REVIEW