HomeMy WebLinkAboutBuilding Permit ApplicationIF
All APPLICABLE INFO MUST BE CO".iPLETED FOR APPLICATION TO BE ACCEP
Date: Permit Number:
RECEIVED
Building Permit Application 19n'' 12 2019
Planning and Development Services Permitting 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
PERMIT TYPE:
Address: ' Y %Q �T�.�O� �I l7G . c ? ��'T /�094fZ7. r- Jr ffs"'i
7-
Property Tax ID #: Lot No.
Site Plan Name: rY4l%Pet2� '%/7-- xd7- s Block No.
Project Name:
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: $S�4�J �� Utilities: —Sewer —Septic Building Height:
Name rrae A_ WI t�z l- Name:
TAT - Alddress: "% q 5/_wzi 5 /ejj 6 Company:
City: rpK% (T / FiQ e State:r—L Address: -
Zip Code: 9 S�/ Fax: City: State:
Phone No. Zip Code:
E-Mail: /y% ��� /�e/� �Ii%}C',� C O,yJ Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
DESIGNER/ENGINEER: _ Not App
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 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 IMPROYEMENTS 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:'
ignature of 0" nef/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF COUNTY OFORIDAFLORIDA
e+��
COUNTYOF
The forgoing instrument was acknowledged before me
this _LA,- day of C �= ___, 20_4 by
The forgoing instrument was acknowledged before me
this day of 20_ by
Name of person king statem nt.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatio
Type of Identification
Produced L_
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. .�������, ELLEN @ GHN
?_° e��:State of Florida -Notary Public
Commission No. (Seal)
=* . Commission # GG 270079
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Rev. 217119