HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE IN O YUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `1 Permit Number: ^nn'n'�
Q? Lucie Counk RECEIVED
Building Permit Applicati[nSEP
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: ass10 ttRL P-DV voDov
PROPOSED IMPROVEMENT LOCATION: V_, : & •pQaPr✓(Lt I
Address: _'91 D 4 �w �A� c +- ��FE w �`t� r P�� u n C ti4' Cam- 3Lko 1 O
Property Tax lD #: Lot No.
Site Plan Name: Block No.
Project Name:�C-�-1� Cflf3(� I�-ITCItC��I
I' DETAILED DESCRIPTION OF WORK:
t7jvlt i7 ((� x 3-1 bvT�onCL— GF1i3h�v } �,§N� qC 6iis�,
I' CONSTRUCTION INFORMATION::
Additional work to be performed under this permit -check all that apply:
—Mechanical
_Gas Tank
teGas Piping _Shutters
Windows/Doors
✓Electric
_ Plumbing
_ Sprinklers _ Generator
1 Roof '5 i Z Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First FIooC
!j� +L
Cost of Construction: $
'7f. t36 o
Utilities: —Sewer _ Septic
1 .%
Building Height: 13 (o
'OWNER/LESSEE:
;CONTRACTOR: `
Name
Name:
Address:_ 011\ t.lw
Company: '12��N 1R� �tj�ll�il S
City: _-k>PU-k C 17/ State: FFL--
Zip Code: a Fax:
Phone No.
Address: l \1-ALA E LC I hsc Sc- E- 1_6f2- -
City:d�+SY'?n Q✓�-P+C I State: F�-
Zip Code: 2`4S_7 Fax:
Phone 'o 77Z -ZI`i -S°iL-1�
E-Mail:_ GI ty C L 5P 6t1v1?11
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail PERGNN lPrl �U11�1i� nA1C
State or County License CRG t °b3 \ I7'1_'1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
H value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
I
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 TITLEHOLDER: _ 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 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 see/Contra or as Agent for Owner
Signa re of Contractor/License Holder
STATE OF FL RIDA
ST E OF FLORIDA
COUNTY OF
COUNTY OF sk. I-ro < kR
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of4 P 113 201l 9 by
this �day of SxQb 20� by
-M
�% �:
�]QO \VUQ •vim V
Name of person making statement.
Name of person making statement.
4I
•,,
Personally Known OR Produced Identific
Personally Known OR Produced Identification
Type of Identification
g
Type of Identification
Produced ti Lam- -
.y
Produced
z
2. =-
Si ota ublic- Stat6 of
I Florida))
(Signature of Nota
SSION#�'022023
Commission No.6C� 25 DST (Seal)
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