HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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 APPLICATION FOR: Mechanical
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PmnerlvTax lD#: �?.C`-1- 7d�'"�1- t�/� I,nt No... '�14 /LJ
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CQNSTRt1CTION li�lFORi1tIATION -
itiona wor"" rformed under this permit-check a11 that appy:
1-1HVAC Gas Tank Etas Piping _Shcitters FI W;ndows/Doors
FlEiectric 0 Plumbing Sprinklers 13Generator 13 Roof
Total Sq.Ft of Construction: So.Ft.of First Floor:
0
Cost of Construction:$ �'� Utilities:U Sewer LJ Septic Building Height:
OWNER/LES5EEO�VTRACTOt'
Name VAUDLt blufdb Name: Y
Address 40 Rrnini by0t0t, Companygttw
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city: Gp e.7- Ivry-e, State:A Address: P�ZU
FIL
Zip Code:_��.�.=.!_..�..v._ Fax: - -- - --- -'---- City: 1_"U ._ �L E:_ ____----- - State:
Phone No.rirn-��-q&- Zip Code: 3W82- Fax:%720-y4$99
E-Mail Phone No. 77,9-M45-/49da
Fill in fee simple Title Holder on next page if different E-Mail: (/ LstG,'p 11Pr t}?tZ5 t�/?07�/?Y1
from the Owner listed above) St or County License: �aAV
If value of construction is$2500 or more,a RECORDED Notice of Commence it is required.
SUPPLEMENTAL CONSTRUCTION LIEN 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 BONDING COMPANY: Not Applicable
Name: 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 Coun 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 revieXr.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 jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
t7Wature of Owner/Agent/Lessee e )S5921ture of Contractor/License Holder
STATE OF FLORIt A
STATE OF FLORI
COUNTY OF 'Id COUNTY OF
The f �oing instrurnent was acknowledged before me The forgoing ins ument was acknowledged before me
this3z day of UArMULI Q 20-M by this631 day omm Lau 26M by
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(Name of person acknowledging) (Name of person acknowledging)
az
Notary'Pub Sta!'SuTM.ii.W..tRES.
{Si&ature of Notary
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Personally Known =:-a*"-,p cation Personally Known 11170 &1enti ict
ifi iii Type of Identi
Typeofldenti cat:10-�, d ficationProduc
Commission No. A, Commission No.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
I DATE
COMPLETE