HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: c, Permit Number:
e ,.
RECEIVED
- -- Building Permit Application SEP 18 ^ ,9
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
P'ROPOSE'D IMPROVEIVIENTTOCATI04 '
Address: ISdrJ W M fl)wm
Property Tax ID#: Q_co&S– Orn– Lot No. (OD
Site Plan Name: Block No.
Project Name:
,DETAILED:DESCRIPTION OF WORK:
T OLfE
I Uhl am Q �h
C'ONSTRU.CTION-I N FO RMATIO 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:$ �U Utilities: —Sewer —Septic Building Height:
OV1l,NER/LESS'EE `' ., CONTRACTOR:
Name 2S 111 Name: i11CS HccC i a �1
Address: ? 0 Company:.(y f t b _ (-AeY 1� a� 0_l t11rC(iyS
City: �_e�QLLI� �u State:VA_ Address: l(' J(') �WCi_l
Zip Code: Fax: City: ,+�1�C.ea State
:
Phone No. al(o" q-1 I" �L4H Zip Code:
E-Mail: + COh'1 Phone No
Fill in fee simple Ti le Holder on next page( if different E-Mail FAG C 'o
from the Owner listed above) State or County License 2 L
03
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.
SUPRLEME'NTAL CONSTRUCT,IQN LIEN=LAVs INFORMATIONa
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 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,"
Signat a Owner essee/Contractor as Agent for Owner Signa u of Contractor/ is nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF Sk. Lyc � e, COUNTY OF Ski 1-vc�e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�`� day ofS-. 20A by this'A day of Z.,-k 5c 20A\ by
�a w.,� � �.��'u 1 t 'S�►ern e S ���'v�'� -
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ion Type of Identification
Produced ProducedMAPt--
fEGNE�`1' `i;
(Signature of Notary ublic-State of Florida) �-- Sig t u r f ""' ubn
NA?MR1�GN 023 ; :aR'• •• EXPIRES:De Underv+r}N�x i
Commission No. G�vGa.A.d�l JSea] 510%# pubC�c
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