HomeMy WebLinkAboutBuilding Permit Application t _
43!'APPL CELE INF6 i111 —gE COMPLETED fOR-AP'PUCATlON TO-BE ACCEPTEt?' '
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ST Lucie Cou rmitting
2300 virgini€r Avenue Fort Paerce Ft,34982
Phnne:{772)4.. 2-IS53..Fax.1772)4521578 �o-nmerciai Residential
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Aadditional work to b!performed;undet:this per rt .,`cfiecl<ail that apply:;,
Mechanical Gas Tank 'GaS Piping _Shutters ' Windows/ 'acirs .
�Electric Plumbing +.Sprinklers generator go f; c "Pitch
Total Sq;'F#,. n # # n 33 �= Sq..Ft of First Floor:
Cyst af.*rcai�s#Tuition f v� f'P tltilitae _SeWe Septic, i3wlding height
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Address: rD ,Cd npany. oo..
Com. . ` �e(c Staie: L Addiessz 3. SC Slue . _C'
Zip Cede: 3 9 y
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Phone=Plo. P72,7-) 1< Zlp C
ode 3 �g 9 7 'Fax: c q.
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Fiil.�n fee sm0t6 Tit 1e=itrrlder'vn next prage if. iffeeent w .E-Mail �c>t[ ed `/�o rs
from tth Wirier listed 4l v' e) State or County.tlten'se
If uaiiie o cbnstriir on i�$2500.ar..moie,O ECORDED notice aiComrnencerhfant is acquired«
if value of HVAC is$74500'or chore,a RECORDEb Notice fof mmencement req!aire z
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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
O�
Signature o Owner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLOR DAA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this?.1 day of��t4 20�ft by thisSLSL day of 2'0�_, by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known 4 OR Produced Identification
Type of Identification Type of Identification
Produced L Produced
(Si ature o Notary Publi ate of Florida) (Si ture of otaary Public-Sta of Florida)
Corn n No. Gr ZG I CRAVJFORD Commission o. "2�5a55
MY COMMISSION#GG265055
gXpIRES.October O:t.2022 �`"`"P" KEGAN CRAWFORD
u4+�� My COMMISSION#GG265055
� de EXPIRE cto er 03,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION i,�%E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17