HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date j)'�`�12-t�Z--cam Permit Number: 14 b3-O a.n
te, RECEIVED
-. ....._......___....____.. - Building Permit Application
MAR 0 5 2020
Planning and Development Services
Building and Code Regulation Division ST. Luci oun , Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residentia
PERMIT TYPE:
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PROp(fr} E - PRbUM!~N, Ep ry TI � r �� � ,
Address: �U� G'�-�o'1 , -{- e� 1• --[C'l� �, .
Property Tax ID#: �y�-'L� Lot No.
Project Name:
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DETAt.EtQIwSt`RPTItaNgE WORK�� �
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Utilities: _Sewer _Septic Sq.Ft.of First Floor:
Cost of Construction:$ L-) Total Sq. Ft of Construction:
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Nam i Name:
Address: �t � CompanyM� ,re�1,�"���✓ ��u L�-
City: State: I Address-Ee2y��
Zip Code: �S Fax: City:1 State:
Phone No. O• Le k,,0•L9 S'� Zip Code: -)LAgS tet' Fax:
E-Mail: Phone No--)11
Fill in'fee.simple Title Holder on next page(if differentE-Mail G2�Gc c�a� .Jl t,�a� tM 1�
from the Owner listed above) State r unty cense '"C5-z -
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.
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SUPPL M N7"�II CQN;+T� CTIUN LIEN LA11/ I FORMAR,
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMP _Not Applicable
Name: Name:
Address: Address:
City: State: city.,,--- State:
Zip: Phone Phone:
FEE SIMPLE TITLE HOLDER: _Not Ap le BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Pe: Zip: Phone:
OWNER/COMMACTOR 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 recordedand posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commenqiDg-
work-dr-rie_cording your Notice of Commencers
Signature of Owner/-Lessee`rContractor as Agent for Owner Signature of Contractor/License 4616r—
STATE
IdenSTATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k- L% COUNTY OF S t
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledge$before me
this S day of V` .d.l 20"° by this 'b dayof+(��l 120'11- by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification L Type of Identif�catt`n� L
Produced Y-1' b Produced N
., NA MARIE GIVENS
RIE GIVEPI5f ;
A. yam:
tr!ISSION#GG 022023
(Signature of Notary Publ - "W-.Fl orl� �MP�ISSION#GG rr e ignature of Mm���'j* _W 1�ilc-SI.Ne b�FIdF X16,2020 i
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EXPIRES:Decem 20`0 Ammission
�. Bonded Thru Notary Public Undenvntefs
e; Nola Public Underx!it Commission No.�r�r Boat + ry N
REVIEWS FRONT ZONINGSUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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