HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� 1
RECEIVED
Building Permit Appli atiOJAN 1.3 ?020
Planning and Development Services Permitting
Building and Code Regulation Division ST. Lucie County,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: IEI�p.
1f
.I li .t hd{.. � �. >r. a t lx { {S �.. W t: { t ® t
Address: ot3(O- -E , "Clyc�o �
Property Tax ID#: �a`�`�-Cao7 o 5q-C�bO Lot No. o�O
a
Site Pian Name: Block No.
Project Name:
WIN
M' "T f al, IRA'#� tAN hr
riser Q { ,
NMI HE ,mo N'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:$ O O Utilities: —Sewer _Septic Building Height:
#I-
4EVEN -
Name � `J. Name: l =' L_ Ma+11In
Address: q`~� a- f��i �1 k, Il . Company:
City: F. P1e�ee' State:EL Address: �
Zip Code: Fax: City: irc 9L' State.F1
axe fir+
Phone No.- sl (3-„ S-�C)o I Zip Code: �j�TZ(-i—
E-Mail: y Phone No LAL4-
Fill in fee simple Title Holder on next page(if.different E-Mail
from the Owner listed above) State or County License e-(2 1(
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.
i wlll�" Enw
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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or andcovenantsthat 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 SIREBEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat. e f Owner/Lessee Contractor as Agent for owner Signa r of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIITA
COUNTY OF S - L COUNTY OF
The forgoing Instrument was acknowledged before me The forgoing,instrument was acknowledged before me
this k�-day of'5a 20�a by this day of 202 a 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 l_
Produced �- L— Produced
t
(Signature of Notary blit-State of Florida ISionature of Nota Public-.State of Florida)
�%qENS
Commission No�Gcy�-�a"� �yAMnR1EGNEiv 2�o ission No. ' _,' a D��
�a DEAN #GG 02 r,• '`-Ally coMMISSI N 022023
MY GOMMISS") 106,20
•:*_:
EXPIRES.December 16,2020
N•
k- c: Bone 7hm Not r)pub w
REVIEWS FRONT PLANS VEGE II Bon e
0--G MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.