HomeMy WebLinkAboutBuilding Permit Application L
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.-
Signature
OMM CEMENT."Signature of Own47 Lessee/Contractor as Agent for Owner Signature of Contracto tens Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF /4/Zr/d COUNTY OF
The ,rgQing it rum nt was acknowledges before me The for oing instrum nt was acknowledgeefore me
thi ay�� 20 by thi fbay o \ �20 by
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Name of person making/statement. Name of person making statement.
Personally Known OR Produced Identification Personally KnownOR Produced Identification
Type of Identification - Type of Identification
Produced Produced
A,1,�
(Signature o Notary Public-State of o ida) (Signature of otary Public-State of F rid )
� M Ewing Marsha E
Commiss'on No. o NOTARY(gIC Commission N NOTARYPUBLIOSeal)
STATE OF FLORIDA STATE OF FLORIDA
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>>> Expires 10/11/2020 O E to/.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ft
TUI R?P20 MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (q(9 9-
Date: C(-a 10— Permit Number:
RECE
SEP 2.3
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epartment
Building Permit Application Parm" N,500Y
OR%,EE
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential DC
PERMIT TYPE:
PROPOSED IMPROVEMENTILOCATIOW
Address: AJ L,:� c, k 3§O/ v
Property Tax ID#: 411—Su1 - oco-L Lot No.
Site Plan Name: 5 k _xd a r4 Block No.
Project Name:
9
DETAILED DESCRIPTION1,017WORK::,.
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CONSTRUCTION INFORMATION.',.
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 ',II - QM Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ILi� go Utilities: —Sewer —Septic Building Height:
CONTRACTOR.
OWNER/LESSEE:E
Name S L%J CIC-N Name: C. -t-'5 ar S C,V,, C,\-
Address: --z4 A q Lka Company: Th,_ 1,,U k' V--(k 61'L
City: State:T--L Address: --I rq ,,-3 <Ve"St-)
Zip Code: '_V4C1.g -7 Fax: city: S yHr-,V State:T--L.
Phone No.(--I
) 5--)-,,-4--wo Zip Code: Fax:
E-Mail: Phone No T�9
Fill in fee simple Title Holder on next page if different E-Mail
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.
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