HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi • l i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q q�
Date: SCANNED Permit Number:
BY
Lucie y
e Count
•
-- — — 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) 462-1578 Commercial Residential
PERMIT TYPE:
J,'PRO,POSED IMPROVEMENT LOCATION:
Address: l9�O qS. O��C�LF� 1�K-• jQis,5aJ, SleaC9 15-7
Property Tax ID #: 5 !' 0Z 57 Z/ 6b D L45ox-� -) Tco 0 Lot No.
Site Plan Name: /(�/L,:rM �DY�b> rt�NZ�M I Block No.
Project Name: 6 N rNG r�).4 I-W Re..0,41 12 S
1 0-
ED.6ES,CRIP'TION QF WORK;,
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rw:4-ct-E To qW¢ CP'L
11"C' NSTRUCTIONINFORMATION _"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: 6 3/6//-rf�-Ar • Sq. Ft. of First Floor:
Cost of Construction: $ 2i; �O yY ' Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
01NNER/LESSEEc
CONTRACTOR:
Name 1^i a /N 1
Name: ffXc& & (7-w,0rg u/L
Address: 2960 S. ace�4 6 e2 •
Company:
City: Je-A)5e-.4J k7 GLl FL State:_
Zip Code: , ? qV ✓t 7 Fax: %72 Z l `l L
Phone No. 2-7-9 `t I `r L
Address: /ZUJ DTJXLZ,
City: -5 —JU?Q Stater
Zip Code: 3y F %�_ Fax:
Phone Nos'772 ) T� 3�Z5-
E-Mail: rG�st a r ZCniJ� ®a tvfQ7
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail�%K2 43c.✓�c COR�C>'/L/�R
State or County License moo 7
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 CONSTRUCTIONLIEN LAW INFORMATION;
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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�IN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING VOURAIWTICE OF CO CEMENT "
Sign�� a of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STf�TE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S t L.L. C I
COUNTY OF I KxX
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this AL day of O C-T a 1e_f ,2 , 20-Lgby
this _aday of J 20j9 by
//
-
Name of person making statement.
Name of person making statement.
Personally Known �OR Produced Identification
- /
Personally Known V OR Produced Identif' AioiY°q'
Type of Identification
Type of Identification
$� o
Produced
Produced
o
Tgaa a <'
_ate nn
- z
(Signature of Notary Public- State of Florida)
(Signature of Not ry Public- State of Florida)
Commission No. G02 l;eal)
Commission No. �� 2l qZ J' (Sea
V P T O
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
-DATE
COMPLETED
Rev. Ll7/ly