HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM
All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Dater LI\— 1�A ` Permit Number: m -(1)as�p
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
SCANNED
Building Permit Application BY
mot. LucieCounly
Commercial Residential '
PROPOSED IMPROVEMENT LOCATION:
Address:
PropettyTax ID #: ``�� -��i�_ 0��� ' OE�o \ Lot No.
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION: I
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: 1 Sq. Ft. of First Floor:
Cost of Construction:$ o� Utilities: _Sewer _Septic
_Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACT R:
Nam O On
Name:
Address:hYJ(z:1\ Q c�C_ V�
Company:
City: State:rc�
Zip Code: �J�0.V� Fax:
� � �J-`��
Phone N(o�
Address:
City: State:_
Zip Code:. a
Phone N6
� �
E-Mail: �\M,00 )
Fill in fee simple Title Holder on next page (if different'
from the Owner listed above)
E-Mail ..
State or County Licens
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: _ 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
T "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."
Signature of Owner/ Le see/Contractor as Agent for Owher
Signature of Contractor/License Holder
STATE OF FLORIDA `�
STATE OF FLORIDA
�
COUNTY OFce0.�
COUNTY OF
The forgoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this or� day of 201q by
this _ day of , 20_ by
47,I oft ,fv � l Y�or�� DRD�
Name of per§6n making statem nt.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public Late of Florida)
(Signature of Notary Public -State of Florida j
Commission No.
Commission No. (Seal)
NAINGRAM•RAHMING
REVIEWS
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VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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) 462-1S78 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENTLOCATION: t
Address:
P to pe rty Tax I D-#:
Site Plan Name:
Project Name:
DETAILED:DESCRIPTION & WORK>
Lot No.
Block No.
CONSTRUCTION; IN FORMATION.
a>
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: Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: —Sewer _Septic
Windows/Doors
Roof- . Pitch
Building Height:
OWNER/LESS(E.
CONTRACTOR:. P 3
Name
Name:
Address:
Company:
City: State: _
Zip Code: Fax:
Phone No.
Address:
City: State:_
Zip Code: Fax:
'Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
It value.of construction is $Z500 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.