HomeMy WebLinkAboutBuilding Permit Application AIfAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �o
Date: j 2� ( Permit Number:
RECEIVED
- Building Permit Application JUN 2 5 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:"
Address: W, r,� -
PropertyTaxlD#: 31403 - Lot No.
Site Pian Name: Block No.
Project Name:
DETAILED DESCRIPTION O.F WORK:
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CONSTRUCTION INFORMATION:,
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Zlectric —Plumbing —Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2 o0 ' Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:e:: CONTRACTOR:
Name R, Si a Name:
Address: C($0:1 Company:
City:�� pi er,_e State:Ft- Address: RQ 1Q
Zip Code: Fax: N�/�. City: 2;��ertz_ Stater
Phone No. Zip Code: 3('(5 a Fax: /V)(�
E-Mail: Phone No al 6— ,_ L Sa-
Fill in fee simple Title Holder on next page(if different E-Mail (2WJy2-i A.0 CSY, Cs 5� AXii
from the Owner listed above) 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.
.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.
1 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 1 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 IMPROYEMENTS 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign Owner/Le.s s e e o.a t rac or as Agent or wne� a ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S- Linc," COUNTY OF
The forgo'ng instrue t was acknowledged before me The forgoing instrument was acknowledged before me
�S'am
this
ay of r�-e 20-a by this 2�"day of LAr4 20 IJ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known i/ OR Produced Identi
Typ of Identification Type of Identification
Pr d ced PAduced
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