HomeMy WebLinkAboutBuilding Permit Application Jul. 31.2029 15:00 PAGE. 1
All APPUCA LE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: L Permit Number: 1 +
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Building Permit Application'
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential _
PERMIT TYPE:
PRfJt'�Si=D'IMPgOUE�VI Ntt
aCA�'IQN ..:;
Address: I-n94q
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Property Tax ID#: ?7 i-(-15-—1 b 5- 1�>6 ,5 - t�5nc w Lot No.
Site Plan Name: Block No._
ProjectName: 0,nM+-01 S
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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: �2154- Sq. Ft.of First Floor:
Cost of construction:$ 4'-3Q0 Utilities: —Sewer .—Septic Building Height:
gW�ER/LES�EE�,.:. . . . ,. . . COhITRA,CTOR�.: •
Name-H.Prh ! Name: 1 41
Address: /„& tin+ (Y r- Company: r-
City: rpt'--- _,T ` I r LQ, Q_ State: Address: E21 VJW MP('L'Qv P _10.
Zip Code: Fax: City: Q�r� _ 1=. n je- State:1_�
Phone No._-- Zip Code -kLo Fax:
E-Mail: Phone Nof_`-j-7;��i 3 (Q,eri
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C�
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I f value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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Ju1.31.2029 15:01 PAGE. 2
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: 4yM _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: may:
Zip: Phone: zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to clothe 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 theermit holder to build the subject structure
which is in conflict with any applicable Flame 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 pians,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."
Signa of Owner/Lessee/Contractor as Age r owner =-TATE
of Contractor/License Holder
STATE OF FLORID F FLORIDA
COUNTY OF L_ Zp-r' COUNTY OF �i ",�e , -
The for��QQing instrument was acknowledged before me The for oing instrument was acknowledge efore me
th�`t�lay of 201q by � ay of. 20 by
Name of pern aking statement. Name of pers m king statement.
Personally Known OR Produced Identification Personally Known X_,OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. :�t;° n; Notary Pu�ate otfiorida Commission No. ;Q4 �, OEad c•pL
Via' `` Commission GG 274604 ` = Notary Public State of Florida
8o ded through Natto I Not
Assn. tai ,° My Comm.Expires ov 30,2022
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REVIEWS FR R PLANS VEGETA ON "' oti tTiiffregion tNJ"R VE
COUNTER REVIEW REVIEW REVIEW -REVI
DATE
RECEIVED
DATE
COMPLETED
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