HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
ERMIT TYPE:
Permit Number: ]q Ick. u4u 1
RECEIVED
DEC .2 3 2019
Building Permit Application permitting Department
St. Lucie County
Commercial Residential ---71
Address: Md-1 -1 AAC- - AO& l iL°1^e'2- ► F11 3�9Ss�
Property Tax ID #: 17r'-' ��/-(—
Site Plan Name:
Project Name:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: hh
Cost of Construction: $`
Lot No.
Block No.
Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name
Address:?'6��. Qi�j�bh 14 t/�--
City: �ohf State:.
Zip Code: S Fax:
Phone No.91
E-Mail: m"k6t.k-tt- RANI4M4! .Cam
Fill in fee simple Title Holder on nLvxt page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 N ATTORNEY. BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of O er/ Lessee/Co actor s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrum nt was acknowledged before me
The forgoing instrument was acknowledged before me
this _-2-&ay of _ 20_!.I' by
MM5� R)CAO�_N__
this day of 20_ by
,
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 FL
Produced
� CIA
(Signature of Notaryublic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
Commission No. (Seal)
�kP8 Pv0, ELLEN VAUGHN
Z A.State of Florida-
-
s ;
= Commission
# GG 270079
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19