HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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DatePermit Number:
- RECEIVED
Building Permit Application 0V 21 2019
Planning and Development Services permltt►n9 Department
Lucle County
Building and Code Regulation Division St.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPO5ED 1MPMV�UfNT LOCATION.
Address:?z-l1rr �G1r�1►'l�� E�
Property Tax ID #: I�J2�CJ.��"Z"`- �l Lot No.
Site Plan Name:���rif�� Block No.
Project Name:�1�1"C�
DETAILED D �SCRtPT1ON OF WORK:
11 -
All r-4 i 5-r
C
TION % FORMATION:ME I RT 0 �'
CONSTRUC\J
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: $ _ r.. L�S� Utilities: —Sewer _Septic Building Height:
OW ER/LESS -
CO TR CTOR:
Name.
Name
Address:,.
Company: ei ( �O 1 S c~�R
City:r-l. ix j. irC- r,. - t'a State:(r
Address:.' - - - -
City I State.
Zip Code:.."TC`-� ,Fax «ti ,
Phone No rr r "'� `
Zip Code:' F`ax;
l one
E-Mail:
Fill in fee simple Titl older on next page ( if different
E-Mail UeL . • C LYY�
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.
0218LEMENTAL CONSTRtU7C,TI-9 tEN W I rOR M ANIO
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
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 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 ;F,OR 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 YOU NOTICE OF COMMENCEMENT."
a ure of Owner/ Lessee/Contractor a t for Owner
Signature.ontracto License Holder
STATE OF FLORIDA `�j
COUNTY OF
STATE OF F RIDA ,nn
COUNTY OF
Th f going instrumen w s knowledge efore me
t day of 20 by
The forgpping instrum t was ackn ledged before me
'this �'Uday of 20 by
111-A-1 T
aYl - �l ���.6
Name of person making statement.
Name of person making stateme
Personally Known OR Produced Identification
Personally Known OR Produc d Ident ication
Type of Identification j
Type of Identification
Produced tin
Produced
(Signature Notary Pu ' - State of Florida)
LLI��hUAUGHN
of Florida -Notary Public
Commission No. K��OFI�my
mission # GG 2700
(Signature of N-
1r� �''• LISA JANE SE RANO
Commission No. � Notary Public -S State l79
mmission 1/� �079
qFc�°•` My Comm. Expires Noy 7, 2023
Bonded through National Nalary Acco
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ion Expiresber
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