HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential L-�-
Address: & 13 A Jc--
Property Tax ID #: "3L(1Q -_5f 0 -n i3C> - CCG - J Lot No. /1?
Site Plan Name: Block No. Iq
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Project Name:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters 7�— Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Constructions
Cost of Construction: $ 11- ,(,c)o
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t1r^�C .-/+C�•.5�. r`
Name: C >1
Addre s: 6 1 Zzfn J A t>-
City: State:
Zip Code: 3��( �02 Fax:
Phone No.
J
Company: 341q1&_)1ic;X'ff Wi') "/'S C045
Address:,, _05_I Vf_54 eAq L,k4
City: r't/ xfrg -6L 1 Stater
Zip Code:33116q Fax: Sly I --,Qcd- 141- 1&
Phone No
E-Mail: bnlz rdi` - 7 r Aaz �<Gfiy)
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail /�/f°c //�/���'�y�cfJr►o �gGt�rnc«j"VS ,Cca►
State or County Licensee./3//S-�C�B
If value of construction is 52500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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'J }
STATE OF FLORIDA
COUNTY OF I f►l'i �GiC�
COUNTY OF Yp�t� 3
The forgoing instrument was acknowledged before me
this day of 20 by
The forgoing instrument was acknowledged before me
this _6) day of rl�:t 20, by
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig ature of 66ta tk'r� K� r LYE _
�� h Commission # GG 208493
Commission No. C�#CG am,n sio(I)es 04-18-2022
Bonded Through - Cynanotary
�. Florida -Notary Public
(Sig ture of tary Public- Stat Florida )
Commission No.Iwi3A KFLLY I
/ , Commission ;. GG 208493
law,.
�, Commission Expires 04-18-2022
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