HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP,_'i FOR APPLICATION TO BE ACCEPTED b y
Date: SCANNED Permit Number:BY
GY IE St. Luce County RECEIVED
•
-- MAR `o62ms
Building Permit Application
Permitting
Planning and Development Services St. dudDepartment
e County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:owrie�r
PROPOSED IMPROVEMENT LOCATION:
Address: EtOo AcmP,n>S rJ� FOr4 1 e'rrP F—e 3�14�f(o
Property Tax ID #: D DO )-0 % 61R'. Lot No.
Site Plan Name:
Project Name:
Block No.
��'�• G _ 11 �� G �' v n • -� G
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 Pitch
Total Sq. Ft of Construction: :?:�' ocz
Cost of Construction: $ /2 0gn0 00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER TIESSEEt
CONTRACTOR:
Name I-Wi4or I�a�c�iwx�s o� iZcriawy 1r3C
Name:
Address: tf2Zo Pi" A01 31 vct
Company:
City: F6.4 N&-Irrg State: FL
Zip Code: 31tq V Fax:
Phone No.
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: Chr;g @ AvJNA r. RVO
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.
UPP.. , �AI G IUSTRL)CTION LIEN LAW IIVFOR
AT1 N:
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
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENT TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOBFORE THE FIRST INSPECTION. IF YOU INTEND TO.O@TAIN FINANCING, CONSULT
WITH YOUR LENDER ATTORNEY BEFORE RECORDING YOUR NOTICE OF ENCEMENT_"
Signatu of Owner/ Lessee/Contractor as Agent for Owner
Signat Contractor/License Holder
STATE OF FLORIDA
COUNTY
STATE OF FLORIDA
OF a
COUNTY OF-44LO9->
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
.l4p0�
this day, o�f p�'n 20_ by
\ h11�'�E� )1249RA
Name of persorl making stateitient.
Name of person maki g stateme t.
\
Personally Known-OR�P.rdducedld'entification y
Personally Known OR Produced Identification
Type of Identification
Type'df Identification
Prod d
Prod ed
i
(S n u of Notary Public- State of Florida)
(S' ature of Notary Publict State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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