HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 �� Permit Number:
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Building Permit Appff tion
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Planning and Development Services %, �y
Building and Code Regulation Division
2300 Virginia Avenue,Fort Piece FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential L/
PERMIT TYPE: 02- i PMMSED 1,1 _WOF 1
RP1WHMRMUEANT OCATION:
Address: �f��Z ��/�C/-� �12-
Property Tax ID#: � 44 d `2- G�� D/9�3 Y 62 e�,-2 Lot No. G -i7
Site Plan Name: Block No. Z-
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Project Name:
DETAILED DE�SCRIPT(M O WORK:
CONSTRUCTIMN INFMRMATIMN:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator J-�Roof 3 i Z Pitch
Total Sq. Ft of Construction: L-�3 33 Sq. Ft. of First Floor:
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Cost of Construction:$ Utilities: .—Sewer _Septic Building Height:
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OWNER/LESSEE: CO NTRACTMR:
Name Name:
Address: S-r)/Z ;,,�/0e%.- p/e- Company: �'���•�i l�j�/G�B7�S �-L�-
City: State: Address: 7`�F:�5
Zip Code: 3.6/q cd:Z Faz: ' City: State: �-
Phone No. . Zip Code: cl y O Fax:
E-Mail: Pho,ne.No 7`7
Fillin fee simple Title Holder on next page(if different E-Mail
from-the Owner listed above) State or County License CGC i3 2- 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMEN AL CtJNSTRUCTION LIEN LAW NFORMATIUN;
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 thepermit 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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIF_
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9day of (` C-�- 20 by this ? day of �� 201 by
MLliff� m UAL Z- W6 0a30 enm
Name of person making statement. Name of person aking statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced 0
(Signature of Notary Public f Florida) (Signature of Notary Public-State of Florida)
ALLEN V
AUGHN Co mission No. .�"""��
Commission No. a % a
o_St �e i Florida-Notary PL blit �: ��= -ELLE
0 Commission f/ GG 2700 9 =y ; State of N VA(J
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REVIEWS FRONT NS VEGET EATI �iSs•o
COUNTER REVIEW REVIEW IEW REVIEW berg , 2r�>fU
DATE
RECEIVED
DATE
COMPLETED
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