HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR-APPLICATION TO BE ACCEPTED
Date: i Permit Number:
JJ RECEIVED
- - - Building Permit Application AUG 13 2020
Planning and Development Services
Building and Code Regulation Division - St, Luc Department
St, Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED'iMPROVEMENT:LOCATION:•
Address: I_7 L* V�
Property Tax ID#: �LLI'�o b`U1 -bc� rD®y ''a Lot No.
Site Plan Name: Block No. 1
Project Name:
DETAILED DESCRIPTION OF WORK:
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FC6LNSTRUCTIONINFORMAT1'0' N:
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: Sq. Ft.of First Floor:
Cost of Construction:$4 al®p Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:, :-CONTRACTOR: -
Name �4av6&4 n Name: E�2
Addresk
��� S R� Company: Mme `
City: f. State: - Address: 1.,
Zip Code:. ax: City: State: r �,
Phone No. " : : Zip Code: Fax: U
E-Mail: -- Phone NoD-
Fill in fee simple Title Holder on next page(if different E-Mail Inii vgi t i i�Lle 60 11 (014-
from the Owner listed above) State or County License (4"(_ 13 00
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.
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 thepermit 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 YBbR LENDER O AN ATTORNEY BEFORE RECORDING YOUR-WTIC.E OF COMMENCEMENT.".
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA —_ STATE OF FLORIDA
COUNTY OF �`X.e;te, COUNTY OF -��1�.Cll�
The forgoing instrument was acknowledged before me The r oing instrument was acknowledged before me
this—.�day of 20 fo
by � . this day of 20 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
/\C
(Signature of Nota Pu -" (Signa ure of Notary Public-St.We of Florida )
ELLEN VAUGHN
Commission N .�.P"Y`°a {Ig Public ELLEN VAI
Florida ebl Commission ,.�"'J�'���
Commission # GG L270079 :o �,; a ®a lorldo-Notary ublic
My Commission Expires =. *� CAmrnitl�lcr� #Od 270978
o '� `, October 22, 202
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