HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a::!an_ DZB�v Permit Number: a,clork::In
RECEIVE,)
Building Permit Application erm FE8 2 � 2020
P
Planning and Development Services st"tting Depart
Luce ment
Building and Code Regulation Division Countv
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: Ra�
Property Tax ID 0 Coi— foco—q Lot No.
Site Plan Name: Block No.
Project Name:
k LAJN'S� A LJ 'CJ 0 3 q_1
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:$ � E-0 Utilities: —Sewer Septic Building Height:
IName Q- Name:
Address: Company:
City: State-.1il Address:
Zip Code: :Z 1=�:J -5!a Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
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.
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
WUM,YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.-
Signature F-6f C5—wn_erTte_s-s` tractor asAgent for Owner
ee/1t1 - — 4� Signature of Contractor/License Holder
STATE OF FLORIDA s'n STATE OF FLORIDA
COUNTY OF 4: Uk COUNTY OF
The forgoing instrumecknow,ledged b��fore me The forgoing instrument was acknowledged before me
2Aay of VZ6
this ,20 4�y this day of 20 by
_
D. pa U(y J I CA&to
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of lclentffica *onType of Identification
Produced— (_ 0 Produced
(Signature of Notary Public-StWe of Florida) (Signature of Notary Public-State of Florida
Commission Na.
Commission No, (Seal)
ELLWVAU�GHN
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S", State of Florida-Notary Public
1 4 Comm*ssi n
NAIWV�l
1,OF K My Commission Expires
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DATE C i MK KtVitW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED .
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