HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COM
Date: / • it - obab-
FOR APPLICATION TO BE ACCEPTED --
Permit N
Building Permit Appl
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
PERMIT TYPE:
G
MF:R
erg- O!'L/[/L
Afyr
Cation JAN 6 2020
Permitting Department
St. Lucie County, FL
Residential /
Lot No.
Site Plan Name: Block No.
Project Name: N/I) �q Y 0'P-_
le + i G e D C%Jln eV eccle. — 1 n-o-a i I Pry 1 h ?Dos
Additional work to be performed under this permit - check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters' —Windows/Doors
Electric _Plumbing ee _Sprinklers
al Sq Ft of Construction: lq2 Ti .
at:of:Corfstruction: $ � 65, Z.5 utiliti
Address: I7-03 r-ccf YaV I-ain e,
City: 'i"r7A Pie✓ce_ State:FL.
1 Zip Code: 5 4 145 Fax:
)Phone No.. 7 7,,p - 3S2-' l l
I&Mail:•^.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
es: _Sewer _Septic Building Height:
Name:
Company: '
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail
State or County
If value of construction is S2500 or more. a RECORDED Notice of Commencement is reauired.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name: &ZA 5. Carrjwe
_ Not Applicable
I I
MORTGAGE COMPANY: _ Not Applicable
Name:
Addregss: h sow{!^ (5elckar
Address:
City:l. t400
Zip:37 77 ( Phone
Stater
City: State: '
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 andtaccesscry' 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 COMMENCEMENT"
Signa "re:ofOwrter/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f rgoing ins ent was acknowledged before me
day 2&P v by
The forgoing instrument was acknowledged before me
this day 20_ by
this of
of
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id 'fication
'Type of Identification
Prord�u/c-ed�
Produced
�L
(Signature N t Public- State Florida
Notary Public- State Florida )
of ry of
(Signature of of
Commission N .,::++i?... :••. AUD'EY B. HU $i'l(ty
Commission No. (Seal)
MY COMMISSION # GG 300817
�s°s P'0ondod
hru Notary Public Un&
nvritera
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3t3PERVISOR
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
ev.