HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _? - o2J-- 1Ci Permit Number:
COUNTY
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 )4- Residential
PERMITTYPE: Me__C1+4A_) IC-4L A /G ehmioGE-6u7-
PROPOSED IMPROVEMENT LOCATION: (Bag4 3
Address: U �D4 -,Z> J 0, LIc a-,n "r r-& —J 1r,0 Z�- -r-O C (_ " 71)
Property Tax ID #:
Site Plan Name:
Project Name: L' . E_1gMh1V
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
T
i�
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 53 02 a'
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Lynn L.eeh man
Name: l`;YYlCU3 I Se�
Address: •bra • 1r �.
City:s'��fT�,/ r� State -FL
Zip Code: 3 Fax:
Phone No. 7 _7 '2- ' Z 2? } &5 Eb
Company: i5 �'r` c Win; U C
Address:
City: ; '('+ Stater
Zip Code. Fax:
Phone No Y� lgtf f
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Obv-r Winds lq
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: _ of 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 that
or and covenants 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 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."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF c
COUNTY OF
The far Ding instrument has acknowledged before me
this day of 1 2a by
The forgoing instrument wa acknowledged before me
this day of �tT= 20Lq by
AL-S-ox
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification K
Personally Known OR Produced Identification
Type of Identificatio
6-
Type of 'fication
Prod ced o
Prod ce __.. U T
JOSE TAPIA
•`x° r'- Notar Public - State of Florida +
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'�µ` Ue . JOSE TAPIA
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atof Notary P `te o4�[t9tiiii�"
' My Comm, xp res May 8, 2022
re of Notary Public SIr�v public - State of Florida:.,°
Bonded through National Notary Assn.
7mm Sion No.
Jgn o: om{�ission !/ GG 2154g7
'' aF r�°' My Comm. Expires May 8, 2022
m fission No. Bonded d I)tional Notary Assn.
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Rev. 2