HomeMy WebLinkAboutROSSMELL, JOSEPH BUILDING PERMIT ST. LUCIE COUNTY 04.02.2020 RevisedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential. l
PERMIT TYPE:
1 PROPOSED IMPROVEMENT LOCATION: a
Address:
Property Tax ID #: _ Lot No. 1
Site Plan Name: Block No. &,25
Project Name:
I DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: t-�quo
Cost of Construction: $ 1d0X. Q0
Generator
Sq. Ft. of First Floor:
/� Windows/Doors
I Roof .�� Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: i�
Address: -lit) s-
�e�
Company:67
City: ._Ze�ev 4 State:
Zip Code: --Z�1-1 '7 5� 1 Fax:
Phone No.
Address: �,f -F
City:
Zip Code-
Phone No
State: ,*
Fax: tA _
)
E-Mail:
Fill in fee simple Title Holder on next page ( if different ^
from the Owner listed above)
E-Mail_.
/State or County License
t`
it 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Nat Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worE<dnd 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 OMMENCEMENT:'
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signat O Contractor/License Holder
L
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF
COUNTY OFF ,
The forgoing instrument was acknowledged before me
The f going instru nt wa acknowledges efore me
this day of 20_ by
this � day of 2� by
a
Name of person making statement.
Name of perso aki atement.
/
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
1`
(Signature of Notary Public- State of Florida)
(5gntui Notary Public- State of Florida )
Commission No. (Seal) r
o isSYl=+da. LFsrvE s nllii (Seal)
^ `.l�J • Notary Pubftr 51dte rat Fiorjda
.,�i�. ✓u'?. CommEssio:i 9 Gc. 18CJ350
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ti Feb 25, 2022
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