HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IIID Is-0 7-0 Permit Number:
•
Building Permit Applica ion RECEIVE®
Planning and Development Services SAN ® �
Building and Code Regulation Division
2300.Virginia Avenue,Fort Pierce FL 34982 ST. LufeCoun
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re rmitting
PERMIT TYPE: r ao
PROPOSED I'NIPRtJVEIUIRN'INM, TION
Address: QO 6hof4 &'D OiC
Property Tax ID#: 333y " s `1 a d " Lot No.
Site Plan Name: Block No.
Project Name:
DETA PRD DE�SCRiPTION O WORK:
1c" P_1CS iti Na eiQ1QQQ, dQQr W i�h !S-1Mel
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CONSTRUCT10041 N' FORMA ION:
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ / ?96.CO Utilities: —Sewer . —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /3D Mew . Name: g,¢C �rl�
Address: (03l Shod Cir Company:
City:—P State:State:Z�jr Address: y<1G4/-.UU.) 042, ,(, J�%Cec)O /3lv
Zip Code: Fax: City: /�SL State: �L
Phone No._ G79S- 9 Y 85_ Zip Code: 34°J � Fax:
E-Mail: Phone No 772 42 �12z
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.
SUPPLEMEN AL CONST +UCT10 LIEN LAW U FORMATION:
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 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 FLORIDA
COUNTY OF Z_> k. L\�c,-R, COUNTY OF �' • l-uc'�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 6\ day of ,20-Ao by this `N day of 20�d by
-,s -" c �) 6V,\-"
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 rpL ProducedL `Dt
(Signature of Notary P lic-State of Florida) f%gffature of M �u,Tic- a % NEMSM.
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IE GIV" •S !> o' °` MY COPdMISSION#GG 022023
Commission No.�s<soa'ad�. N eal) Dt11NNAMAR GG 268Fnrrirssion N a ES-Decerrk$Pe N20 'P
EXCPOIRMESI:SSOce�#ryMYi• Bonded Thru Notary Pubic Underwriter
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REVIEWS FRONT O SOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER EW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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