HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COhiIAETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application SEp2
Planning and Development Services Per i19
Building and Code Regulation Division St.t`epa
90
2300 Virginia Avenue, Fort Pierce FL 34982 ��e cot
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: 4W-Al, /I/ #W�- X4 4 t f /�''� . FL.. 3,,
Property Tax ID #: 14/ T /7V Lot No.
Site Plan Name: Block No. 4
Project Name:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction: j
Cost cEflCon ion S ,
Name
►AA
Windows/Doors
Generator ' _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Address: �'`fOrD �i F`14C7'L'r%
City: Ate,
Zip Code: Fax:
Phone No. '�%.- 6712.�-',.,,���
E-Mail: 1v;o_o r��l�'C" ��Di� �OhaG3� C�h7
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:. qrM. a 7.CM X"tM"' .10/e,44'o
Company:iiftF''%c�i''
Address: /3,360 "JAB` 40 sr,
City: %,., State: fi-
Zip Code: 30 f Y-57 Fax:
Phone No "—cJ 96-6
E-Mail Mygs o 1,ocPog► 9'-y-a1,OD..,. aern
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.
DESIGNER/ENGINEER: —Not Applicable
Name:_
Address:
City:
Zip:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable_
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FL RI �I
COUNTY OF
The f oing instrument was acknowledged before me
thisday of 20(4 by
e� Di-4eoiz�
Name of person ma ing stateme
Personally Known OR Produced Identification
Type of Identification
Produced
Q1>IW Q Jeri Dee Dausey
(S ature of NPry „ b �r,= t. f9f95i6BidiG012i936
Ypires: Sept. 27, 2021
Commission No. i;.�,:,ud-1;i;U )Notary
Signature of Contractor,
se Holder
STATE OF FLORIDA /
COUNTY OF 3t-- I � I, 'uQ,
The forgoing instruirpVnt
was acknowledged before me
this`LDd of 20V by
C RN
Name of person making statement.
Personally Known OR Produced Identification _
Type of Identificati L
Produced R(
(Signatu
1 LLEN VAUGHI�,.
tatP of Florida -Notary
Commission # GG 270079
My Commission Expires
1,1;61 c
o_er ' 2,
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Rev. 2/7/19