HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I �3 ► q Permit Number:
SCANNED
Le BY
--- — - , Building Permit Application St r_ucie County
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
PERMIT TYPE:
PROPOSED
IfviPRo- EMENT LOCATION:
Address: 1661 sIF]-
Property Tax ID #:SLJ 1 Q, 60r;Z C00 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WO K:
;Q 0W&
to 1A{asD21I D i Mai IEiq C },n
bUnno. [_D0t 5
CON RUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank - _Gas Piping _Shutters _Windows/Doors' '
_ Electric -Plumbing _ Sprinklers _ Generator- — Roof " t-Pitch,
Total Sq. Ft of Construction: 70o Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height: S T-f
OWNER/LE-55EE;
CONTRACTOR:
Name S
Name: Q V%d lJ i
Address: "7WI S ��1w ttiy or
Company: Ow- 6&-4rv-I LI-C-
City: %H QtCYC.- Stater
Address: 70r') 5 29+U SY�
City: Fnir WC— Stater
Zip Code: 549"1 - Fax:_--'
Zip Code:. �!)!4 Qsi Fax:
Phone No. 9 j 8-- U6* - 0,50cf
E-Mail: (n�n:Co('� L7 t1 CpMCvjt.nC r
Phone No 779-93%-i2W?
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 6,w oes) dJ+ ', o-`S)Ao�N , uca-i
State or County License cao D (9 )go
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.
�O
DESIGNER/ENGINEER:. ,
Name:
Q
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip_ Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association* rules, bylaws or anxcovenants-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 Ynl in 1 FNnFe ne-AN ATThg)IUFV RFFn DF DFrinDlHlur. irn11D mnTIrF nF rnmm F%irFMF1uT•t° '
/Y I Ujk-,,-
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA .L 1(,, COUNTY OFif—
The
inr n wg ins as acknowledg before me
thistday of 20a by
Name of person making statement.
Personally Known OR Produced Identification
Type of IdentifiS"n ,
Commission No.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Thefo nginstr t as acknowledge before me
this day of 20f a by
Name of person making statement. /
Personally Known OR Produced Identification Y
Type of Identifiya>:ien
(Signature of N�
ELSEN
tart' Public Commission No.
i'207484
'Expires
REVIEWS FRONT COUNTER { ZONING
, S RP— EV—I
DATE
RECEIVED
DATE
COMPLETED
E. `_ ffieffM filia*hary Public
* Commission 0 GG 207484
My Commis y 1. piles
°F June 1
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