HomeMy WebLinkAboutBuilding Permit Application All A.PPLICABLEIiVFO:'MUST BE"COMPLETED-FOR APPLICATION'TO BE ACCEPTED
Date::, eq ka: Permit Number: a.a c'�6 _tcb as
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Building Perini Appl eatio f,"v S 7 . 320
Planning anONyeloprnentSer•vices
Burldmg and.Code Regul6t on'Division S1. Lucie County, Permitting
2300 Virgrnra Ayen ue,',Fort Pierce FL 34982
Phone. (772j 462.'1553 fax:.(77zj 462-1578 Commercia . Reside"ntial .. : . ...
PERMIT TYPE
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Address: Z�� .I�PCcch B� h ke Cr'!' C�C
Property Tax 1D#: �. I C - a 6 g-.C�6 6- Lot No.
Site Plan Name: Block No.
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AddEti _h, work to be;performed 'under this permit. 'check allahat apply:
_Mechanical _GasTarik' Gas Piping _Shutters Windows/Doors
Electric' Plumbing. _Sprinklers Generator _ Roof Pitch.
Total Sq Ft`of Construction: Sq:Ft..of First Floor
Cost of ConstrWetion ;$ �S', � _. Utilities _5eWer 'Septic Budding Height:
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T s , F +F. Gt?NTRACTOR.x 3 f r kt
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Name l r 'C f,5('D N`a'me
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Address SCh �l�l �, jGle C
v �,L�c'
city. Statel Address � -
Zip.Cade: 3`T . Fax! State,
Phone No. d,`t+ + _ 7 � -
ZipCodea��i _ Fax
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Fill m fee simple 710 H®Ider on next-page(if dlfFerent E=Mail
`from the Owner listed,a(bove) State or County Licensee®
4 If value of const"ruction tir$ more,a RECQRDED•Notrce:of to is required:
If volae of H1/AC 1.$7,500 or_i"nore;-a`RECORDED,Notice;of Commencement>s:repuired
SUPPLEMENTAL CONSTRUCTION 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: 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 thepermit 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 COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S+ .I---k&G I COUNTY OF S± , L—Ul_G I
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this I day of MO,0 20_ by this day of if'�? a 120a0by
15
Name of person making statement. Name of person making statement.
Personally Known 'y\ OR Produced Identification Personally Known/'vOR Produced Identification
Type of Identification Type of Identification
Produced Produced
r �
(Signature o (Signature o 11F& ?ublic-
iiaYbiia.. :; �:
LUANN O'CONNOR ( Notary Public.State of Florida
Notary +"w
Commission �; y Public-State 46aZI)da Commission o;i o ° Commission X GG 27g98al)
ommission a GG 270518 y omm.Expires Oct 23,2022
My Comm.Expires Oct 23,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19