HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ���/ Permit Number: —
, ii.� u RECIV�D
------
JUL ®.,9 1
019
Per
_ Building Permit Application mitt,,
CartPlanning and Development Services St' Luc;DCoUn y�i
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
i
P + OSED 1 PRONE E-���� LOCA IC�}'
Address: �,� \
Property Tax ID#: 1_0 0— 5 l )agrO 00-!] Lot No.
Site Plan Name: Block No.
i
Project Name:
I_
t?ETAiLED D.ESCRIPI"iON Uig WORK:
CO S FRt1 IQ 1�1'FC3RM ;TIQN:
Additional ork to be performed under this permit—check all that apply:
echanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
;
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
I
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
I
UW �E�RjLE=SS�.E: " GONTRACT�R:
R
Name t Name:
Address: , k,\'J �a Company: '
City: a,U� State.r Addre s: S.
Zip Co.d.e:3 F^ax: City: � State: FtL_
Phone N23 _ �.—•� 0� Zip Code: Fax:
E-Mail:, Phone No /1
Fill in fee siimpie Title Holder'or next page(if different E-Mail
from the Owner listed above) State or Cou ty License(`
i
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.
i
i
FPLEMNTAL CC?NSTRUCTIC�N L E L4W INFORN9ATICDN:
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 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 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrume t vffs acknowledge�efore me The fo ing instrument was ac owledged before me
this 9\-day of . . 20 L by this Ida of 20gby
Rkmc, (,)5, �tu -
Name of person aking statement. Name of perso i'making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio (� Type of Identification
Produced u )� Produced
(Signature of Notary Public-Sta e of Florida) (Signature of Notary Publi -State of Florida)
Commission Commission No. �' al
otP �a,% EN VAUGHN ;bt YP�I, ELLE i
,2 _State of Florida-Notary Public ::State of"F ELLEN),"
_. N-
; Of{��0`` MY ommissi n Ex it 79 a; °mmission#G�, 2y ublic
REVIEWS " OcimbM 202 SSP VISOR PLANS VE �f i`�f� 4=22,
in x VE
IEW REVIEW R 2 22 R I
DATE
RECEIVED
DATE
COMPLETED
ev.