HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: oC % a 0 Permit Number: RO.14— 0 2 /L
9Mo [LUME
Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579
PERMIT APPLICATION FOR:
Address: IQ B O
PropertyTax ID #: 13 G 1 -jai I ' (OLlog ()() i - Lot No. Z LP
Site Plan Name: I- Q )Ce L X( Wl ?f4K9 r by)) I � Block No.
Project Name: V4J H Y'l I) C�
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Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters V windows/Doors _ Pond
—Viectric —viumbing _ Sprinklers _ Generator _V*�Roof Pitch
Total Sq. Ft of Construction: 'a 9 3 3 Sq. Ft- of First Fl ) to150
Cost of Construction: $ 115 15 00) Utilities: _ Sewer v Septic Building Height: 1 J
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Fill in fee simple Title Holder on next page (if diffeMeMr
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from the Owner above)
State or County LicenseCGLT,!;rMW�g Try-,
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:=
DESIGNER/ENGINEER:
Name: 3 L
Address:C1C.,
City:
Zip: 0 Phone
_ Not Applicable
Ve,1
State:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Countyaq posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len or ah attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Less ontractor as Agent for Owner Sign r f Contractor/License Holder
STATE OF FLORIDA STATE OF INDIANA
COUNTY OF 5rr_-ra-rdi COUNTY OF HAMILTON
Swq to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Onli a Notarization V Physical Pre nce or O Ine Notarization
this day of 2020 by this!) day of 2020 by
Gc-1
Name of person makin atement. v
Personally Known OR Produced Identification
Type of Identification
Produced
(signature of Notary — —
NO" PUN@ am of fidiM
Commission No. pQppu
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REVIEWS
FRONT
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SUPERVISOR
COUNTER
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Name of person ma ' g statement'
Personally Known OR Produced Identification
Type of Identification
Produced40vo,p'-w
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_ (Signat r of Notary Public- State of Indiana )
tiro •,,, Yvonne M. Senesac
Commission No. 0664315 ;',;o.''; Hamilton County, IN
My Commission Expires
REV EW I V EV EWON I S EV EWLE M EV EWVE