HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: Permit Number:
RECEIVE®
00T 3:.2019
- Building Permit Applicati n
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address:
Property Tax ID #
Site Plan Name:
Project Name:
5 11-410_ dlN�- (5r36- 3
Lot No._
Block No.
Additional work to be performed under this permit— check all that apply:
✓Mechanical —Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
--Electric Plumbing _ Sprinklers _ Generator ✓oof�-Pitch
Total Sq. Ft of Construction: (aQ1 Sq. Ft. of First Floor:
Cost of Construction: $ %c3I n z 00 Utilities: _Sewer _Septic Building Height:
O 4"NER/LESS®EE:
CONTRACTOR:
Name_ (;�I-(`l) t—L'A-AJI
Name:
Address: �5 OOC
bk
Company:
City: _
Zip Code: S�� Fax::
Phone No. .7 7A — "9-- 36
State:
Address::
City: -- State:
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
Name:
Name:
Applicable
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:.
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AF,FIDVIT:.Application'is hereby.made to.obtain.a permit to doAhe work and installation as indicated.
':.: .
I certify that no work or installation has commenced prior'to th'e issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to buildAhe 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; .imall-respect's; performAhe 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 LEN ER OR AN ATTORNEY BEFORE;RECORDING YOUR NOTICE. OF',COMMENCEMENT.":-
ev.
DESIGNER/ENGINEER:- Not Applicable MORTGAGE COMPANY: Not
Signature Owner/ Le /Contractor Agent for Owner
Signature of Contractor/License Holder
of a as
STATE OF FLORIDA
STATE OF FLORIDA -
COUNTY OF-6 k
COUNTY OF
The forgoing instr ent was acknowledge before me
�� %�
The forgoing instrument was acknowledged before me
this3� day of , 20 by
this day of , 20_ by
G'�Q1'.:.s1,,n
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 � �' � L •.
Produced.
(Signature of Notary o or�fJNp,p�gRIE
# GGs 2020
(Signature of Notary Public- State of Florida ).
;�• � = MY COMMISSION
Commission No. �i'6 O : •� @� oecemi�r
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Commission No. (Seal)
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