HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COM.=__iED FOR APPLICATION TO BE ACCEPTED vi
Date Permit Number: L no
RECEIVED
Building Permit Application FE9.03 2020
Planning and Development Services Per"Ili6g Department
Building and Code Regulation Division St- Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential t/
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: �Nl�l j 001) 1-NA ) r
PropertyTaxlD#:i3'?,�-56 &—OO-6d^yOd - `► Lot No. iCA
Site Plan Name:, NASA A 0-0 ORA , Block No.
Project Name:j rM 4 U/ i aL,
°DETAILED;DESCRIPTION OF WORK: -
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric Y-Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ aq GG
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name NL
Name:
Address: --b r
Company:
7
City: 1 Stater
Zip Code. 34,Q5 Fax:
Phone No.`s Q 1 (n ROG Z
Address:
city:* ( ( D ► Q 0 Stagy i�
Zip CodeFax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
1 (( n J) I Q 'C'. 00
State or County License Q—rC, 5 5i Q ( a
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.
'SUPPLE MENTALCONSTRU LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City:` State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 ffygLNEY BEFORE RECORDING YOUR NOTICE OF C ENCEMENT.11
Signature of Owner/ Lessee/Contractor as Agent foYltr
Signature of Contractor/License Holder
STATE OF FLORIDA. t Lu C A Q
COUNTY OFF
COUNTY OF STATE OF ORIC� L ( � V
The forgoing instru ent s a Anowledged before me
this `�l day of , 20 `�Q/
The forgoing instr ent acknowledged efore me
this, day of �, 2 y
Name of person making statement.
Name of person making statement.
Personally Known / OR Produced Identification
Personally Known --k/— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature ofQlo9ry PubliV State of Florid
(Signature o !ary Pub c- State of Flori a
`µro"••.,, KARLEYMARIEGIESY-VA'
Commissio N dal)
u ¢-State offlorida
CommissionOGG099801
, KARLEY MARIE GIESY-VARNE4
Com A• (Seal)
��--NeMrpfnMie-itateroffiogda
' Commission# GG 099801
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