HomeMy WebLinkAboutBuilding Permit ApplicationAN APPLJCAqLE IN MAST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! i 41 Permit Number:
1
Building Permit Application
Planning and Development Services .
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pkrce FL 34M2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address:n
PropertyTax lD #:
Lot No.
Site Plan Name:
Block No.
3
Project Name:
ice.^^�.Fa-4=�'y'(4�y�1-}�� {a'S fn1J�,y3
Addilfonal work to be performed under this permit —check all that apply:
XMechanical _ Gas Tank _ _ Gas Piping _ Shutters Windows/Doors
Electric — Plumbing _ Sprinklers Generator _ hoof , Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor. _
Cost of Construction: $ co Utilities: _ Sewer _Septic
City: ,-Z
Zip Code:
Phone No
State:
nil in fee simple Title Holder on nod page ( if different
from the Owner listed above)
of construction Is $I= or more. a RECORDED Notice
Building Height:
_. icpc L► � I
a
Is required.
if value of HVAC is $7,M or more, a RECORDED Notice of Commencei0ent is requited.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
NEER: Not Applicable I MORTGAGE COMPANY: y Not Applicable
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X. Not Applicable I BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:_
Zip: Phone:
Zip:
Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 CO ENCEMENT MAY RESULT IN YOUR PAYING
TWICE F IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OPICOMMENCEMENT MUST BE RECORDED AND
PO N THE JOB SITE BEFORE THE FIRST INSPECTION. IF OU INTEND TO OBTAIN FINANCING, CONSULT
WITH R LENDER OR AN ATTORNEY BEFORE RECORDING YOM NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature o Contractor/License Holder
STATE OF FLO�n A/L
STATE OF FLORIJ�1/�� f
COUNTY OF lxt ��
COUNTY OF �"L 7 !�
The forgoing instr e t s acknowledged before me
day � 20LI by
The forgoing instr ent as acknowledged before me
this day - 20L by
thi� of
n)? of, .
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
(Sig re of Notary bLc- State of Florida)
(Signs otary Publi - State of Florida I
Commission q."., ,•. N A. Pj1�Nl1jCOLl
' STEPHEN A. PIIOLI
Commission �•'"' ."
'��'• ;•= MY COMMISSION #FF972442
MY COMMISSION # FF972442
'•
REVIEWS (4o
?f �`;.`
)3*R F1
VISOR
PLANS
(407 "39MI
Floddallolar/SaNIC6W
GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19