HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:, ) " �T) Permit Num
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462,-1578
PERMIT TYPE:
Building Permit Appl
Commercial
cation MAR 01 2020
Permitting Department
St. Lucie COunty, FL
Residential
• • - LIls�LC�LL�[�I,'L!�cJLZYl'1l=1�/71'�:Lit�I
Property Tax ID #: rN Lot No..�
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank j _ Gas Piping _ Shutters
Electric _ Plumbing l _ Sprinklers _ Generator
Total Sq. Ft of Construction: t Sq. Ft. of First Floor: _
Cost of Construction: $ / Slop b Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
a N R lES5EE:
�C1NT ACTC}Ft:
t�
Name C i 14M
�S
Name:
Address6`69-.� 'S QCEAM (6
City �1 � �A C h
Zip Code: > % Fax: 11
Phone No. ®� -
State .p ' „y
att
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Address4 y
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City: -'� >i!-??;-� '{ State:
Zii'Tax:
Phone No
E-Mail: Ckfifflid d5 AL gOADL .0 W\
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
I
E-Mail
State o ounty License
If value of construction is $2500 or more, a;RECORDED Notice of C mencement is. required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Compfencement is required.
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DESIGVR/ENGINEER: ' Not Applicable
Name: 491C. fiA rf-&>=IMI s�jA9
Address: P Of 5iP I
State: W L
Zip: W 3q-qs-ct Phone' _ ,9— dls-S6a3
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
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, perforrn'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."
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natu o`f • wn� r,/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID A^
STATE OF FLORIDA
COUNTY OF �9f C�'2Q/
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisof m .P 4P_C44— 2� by
this day of 20_ by
11daay
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced psi e 1)0 E 2_, C -
Produced
(Signature o o ary Public- S
'of Notary Public -State of FloridaAUDREYB.HUMPHREYCommission
No. ='*;(pMMI$SION#GG
[nature
Itossion No. (Seal)
EXPIRES: March s, 2023
Thtu Notary Publa UM
rs
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SUPERVISOR
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19