HomeMy WebLinkAboutBuilding Permit ApplicationAPPLICAB�Ilf
NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
te: CiaPermit Number: P 06 'o��Alp
ing and Development Services
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
!CONSTRUCTIONINFORMATION`:
Building Permit Application
Commercial X Residential
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
v'Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ At.Q- 06 Utilities: —Sewer _Septic
0
_ Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE
;CONTRACTOR..
Namejt��.�cJ
.9
Name:
Address: 2 D &
Company:
City: AA State. _
Address:
Zip Code:Fax:
n
City:State:
Phone No.
Zip Code: qj19,%6 Fax: 49,7-46/- 77f,
E-Mail:
Phone No 177.2 -
Fill in fee simple Title Holder on next page ( if different
E-Mail fill kiL & Dih i �.t- -,4A6c t i C" -
from the Owner listed above)
State or County License eG /300-,5939
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.
L
ENh7aLCNST.x`_"'I' h TiMt1 AT�-
I
17 fi
DESIGNER/ENGINEER: —,C 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:
City:
Address:
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 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 fifff BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER QU AOJ ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM N MENT."
bml� V-4
I Signatif4of Owner/ Le ee/Contractor as Agent for Owner
SignagrLIM Contractor/Lice se Holder
STATE OF FLORIDA
COUNTY OF 53t
STATE OF FLORI A
COUNTY OF S LvCie-
The forgoing instrument was acknowledged before me
this day of�) i/�- 20_M by
The forgoing instrument was acknowledged before me
this dffa''y of \'r�u.� , 20 L4 by
Name of person making statement.
Name of person making/statement.
Personally Known OR Produced Identification
Personally Knowny OR Produced Identification
Type of Identification
Type of Identification
Pr uced
Produced
(Signature of Notary Public- State of Florida )
Commission No. C—tC—LaF—ID5X NOTARYPU
IDA -+STATE OF F
(Signature of Notary Public- State of Florida)
NOTARYPUBLI
STATE OF FLO
Commission No. C"�"i����!sOZ&.It_Comm#GG2870152
G2
Expires 1/26/2
023
Expires 1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19