HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( ' ��' Permit Number: 1 l 0611• D
RECEIVED
- 5 .2019
Building Permit A plicati
Planning and Development Services Permitting Department
Building and Code Regulation Division -
2300Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: cc C44
Address: (01 82 6t
Property Tax ID#: "gitl �'o c2t2 CW 6 Lot No.
Site Plan Name: Block No.
Project Name:
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:$ - 00 Utilities: —Sewer —Septic Building Height:
Name m
I/r Name: l
Address: �� Company: P61 INT xd&�Qavf
City: _P Pf6& State I Address:
Zip Code: Fax: City: : , State:
Phone No. Zip Code: Fax:.
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
.,r
from the Owner listed above) 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.
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 AFFIDAVIT: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 IMPROY�MS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE-10E SE BEFORE THE FIRST INSPECTION. IF YOU INTEND-T07"TAIN FINANCING, CONSULT
WITH Y Jt- NDER O ATTORNEY BEFORE RECORDING YOUR NO CE OF COMME CEMENT:"
Signaturd of Owner/Lesse Contractor as Agent for Owner Signature ofltontractor/ icen�e Holder
STATOF FLORIDA - STATE OF FLORIDA
COUNTY OF COUNTY OF
The for ing instru nt was acknowledged before me The forgoing instr ment was acknowledged before me
this day of 20� by this day of 204 by
Name of person making statement. Name of person making statement.
Personally own OR Produced Identification Personally Known OR Produced Identification
Type of Iden 'fi i n Type of Identif ca bion
Produced kc , Produced IA
(Signature of Nota u ' - — i (Signature o Nota ublic-State of Florida_)
AUDREY B.HUM HIRE, 5
Commission No. °': YCOMMISSI0 ��300817 I UL AUDREY B.HUMPH%Y i
o EMY w
XPIRES:March 1).2023 I Commissi f ': IggION h SG
•°'TFo� .00 ndedThruWtMi Pubr'cUa,'envri:ars _ `o EXPIRES:Marc ,2023��1).K
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