HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /�
Date: ` l Permit Number:.. 19. h`p 1 _(N2
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462=1553 Fax: (772) 462-1578
;. RECEIVED
Building Permit Application
Nov is 2019
Permitting Department
St. Luc my
Commercial Residential
-Add rese �� b ate; 6K 4, 4T 6-, (700 5 ry f I- � R Ic
Property Tax ID #: balo Cl i u I- 4 O-V;)- oot>-.a- Lot No._
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank' --Gas Piping _ Shutters
Electric —Plumbing, '.—Sprinklers _ Generator
Total Sq. Ft of Construction:. 11, !el) 19, OLD Sq. Ft. of First Floor:
Cost of Cons truc`-�-tio "! ®0 Utilities: _ Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height: .
OWNfR/LESSEE:
CC} RTRACTOR:
Nam - CA-9-3
Name:-
km
Address:
Company:
City: `' _ i �, 1 ,w `` State: _
Zip Code:.. ";,Fax: '
Phone No. �%`• C1
Address:
r
City: I
Zip Code:
Phone No
co.`,'.
Fax:
-State:
_
E-Mail:'
Fill in feesimple'Title Holder on next page (if different
from the Owner listed above)
E-Mail ��'T,C
Al Tt /q/CT
State. or County Licensee'— G Q
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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/ENGINE R: Not Applicable MORTGAGE COMPANY: Not Applicable
.. �.�
Name: Ili C I ame:
Address.) n �' �' v L AL_ Address:
Cit 0 Sta e: City: State:
Zip: Phone `Xp W — _4 T'SZip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _ of Applicable
Name: Name:
Address: Address: .
City: City:
Zip: Phone: P. 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°-'
worn vnmio i cunco nn Au wrrnoNcv 12CCnDF Dvrnonnur. vn11D NATIrF nF rnmmFNCFMFNT_"
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Signature of Owner/ Les-see/Contractor as Agent for Owner
Signature o Contr'actor/License Holder
i
STATE OF FLORIDA S-� L�
STATE OF COUNTY FLORIDA �
v
COUNTY OF
The forgoing instrument as cknowledged before me
The forgoing instrument was acknowledged before me
this gt, ay of 20 A by
this may of CQ 20 J, y
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Name of_person making statement.
Name of person making statement.
/
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Personally Known OR Produced Identification ✓
Personally Known . OR Produced Identification
Type of Identificati
Produced
Type of Identification
Produced'
(Signature c- State of Florida)
(Signature of Nota x Florida')
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Commission No. •: r�/e d<<F
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