HomeMy WebLinkAboutBuilding Permit Application2-Qej ov
Lot No.
5 `j_,,r . tJ Block No.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: _(�J
Building Permit Application
anning and Development Services
jilding and Code Regulation Division
300 Virginia Avenue, Fort Pierce FL 34982
hone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
ERMIT TYPE:
R.QPQSED 1MPR�VE'MENT �OCATtON.... a
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PrIoperty Tax ID
Site Plan Name:
Proiect Name:
oWIR/LESSEE ;.
CCENTRACI oR v
c
Name r' A- <,3
Address: a
_�Company;��� M �` CQGOt
AddresUDL1' 13_W.. Li. W S r-eej
City: c- lam:" ram -. State:f�C_
Zip Codeit'. ( Fax:
City c!`c�+ Stat�L_
Phone No.(77�� 6/2_17 -333/
Zip Code: a Fax Mad
E-Mail: 45_a�iNUbs:G(�1r ,I-Qo(vV ,A I-L-_oi.,*'N-
Phone N `iI
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County Licens"-C413?$(v
jQib
114 te-t
If value of construction is 92500 or more. a RECORDED Notice of
Commencement is reauired.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPCElVIENTAL CC?NSTR"UCTION LIEN
LAW [NQRMATIQN
E
y
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
is in
which conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
Please
structure. 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Co tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5 Yl-w.-.
COUNTY OF S- - L,,
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this '9r day of k gt.% 20A by
this may of 20a by
Name of person making statemen .
Name of person making statement.
Personally Known ,/ OR Produced Identification
Personally Known !� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of taryIc- State of Florida)
(Signs u e of Notary di. ate dM§1Ift0BS0N
* MY COMMISSION # FF 201399
°:%�•P�
Commission No. * al) ROOFR.IACOQ�N
EXPIRES:M h
Commission No. N'" °P dedThruSuOel-��8erv�
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FY � ,r•, FF20
REVIEWS
FRONT
OF FLo Bm,
ZONING
led Tr;,u.6oJ I ay. 3,2019
SUPL ' -Rki
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19