HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST13EE COMPLEl'.CrOR APPLICATION TO BE ACCEPTED
Date: q MPermit Number: dd da-b�jq,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: Ln
Address:
Property Tax ID #: _ c -� W
Building Permit
Commercial
RECEIVED
Applicati n FEB 14 2020
sr. Lucie County, Permitting
Residential
Lot
Site Plan Name: Block No.
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: $ Utilities: —Sewer _Septic Building Height:
WNER/LESSEE:
RMITO CTfl'R:
Name W (
Name:
Acidres ' � UQ6 �. J Y i \Y
CompanV
City: V'R State:
Zip Coder• � Fix:'
Phone N8 �t�J -I� - �L�
D
Address:
r
City: �
Zip Code:
Phone NO
State. _Q
Fax. 'O1
- R2v
E-Mail: iC-10 •a. )Irw.
,(*mail•
Fill in fee simple Title Holder on neW page ( if different
from the Owner listed above)
E-Mail
Krl�-n • Ft) �Iar
D @ Q1lCl acs , cra n
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.
SU PLEMENTAL CONS 0I0N 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: Applicable
Name:
_Not
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
"WA O O R FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
F IMPROYEME S TO YOUR PROPERTY. A ICE O MENT MUST BE RECORDED AND
:CE
ED E JOB SIT BEFORE THE FIRST INSPE ON. IF Y U INTEND OBTAIN FINANCING, CONSULT
1Y R L N OR A ATTORNEY BEFORE RECORD OUR ICE OFIC MMENCEMENT."
Sign ure of Own r/ Lessee/Contractor as Agent for Owner
Signal re of C ntractor/License Holder
STATE FL IDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF St
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this !J__ day o� 2QQQ� by
this Ll day o 2QSD by
L—c C' V �C �c��cc1
(",/ C--�
Name of person making stat ment.
Name of person making statement.
Personally Known >(_ OR Produced Identification
Personally Known X___ OR Produced Identification
Type of Identification
Type of Identification
ProdU e< iblic State or Florida
,+ Angela M Boo re
g My Commission GG 19060e
�ja Expires 02/2712022
Produced 00 Not hilt State of flodda
Angela M Boore
' , ,�+' MY Commission GG 1806oB
ppa Expires 0212Z,/2022 ,
(Signature of Notary Pu Ic- State of Florida) ` '
(Signature of Notary Public -State )
Commission NoC�^���C( (Seal)
[[off��Florida
Commission N—i��iva7-1 (Seal)
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