HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1f
2
All APPLICABLE INFO MUST BE COMPLETED FOR
Date:
CATION TO BE ACCEPTED
Permit Number: qou ' wsQ_1'
9
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
t Application
RECEIVED
JUN. 2 2019
Residentiiai
ent
CL•. A �fa'fRe F"[IIftSP(!
F PERMIT TYPE:
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Address: 0715 Aoe&,1oa5IgC. t
Property Tax ID#: p� 9® 60� ad?5--000-�
Site Plan Name: /� I'd k/ys�
Project Name: I a ki�%
Lot No._
Block No.
Additional work to be performed under this permit — check all that apply:
-/_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
V Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ - _4A5r&L-/ Utilities: —Sewer —Septic Building Height:
i*3iU"iRAC'TC+)R:
,I
Name .IC�1'/�Cf1�, 6�!/1 kr�
Name: I CV0
Address: i 13 5 A apal ea ic, C
Company: C G 1) e-
City: '� State:
Zip Code: 3 F "" Fax:,
Phone No. 7 7(�Q-�f�'L
7`7
E-Mail: ,, .._. 1.�_....: _� .. ,�._� �..9;.. _....,.
l *'i i ,
City T ,� ` Stater
'Zip Code:
~Phone No 771 5 l q e0 -7 7Z
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail C
State or County License c-
If value of construction is $2500 or more, a RECORDEDi Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
L N AC r4NSTR C1 MR MIMI
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
'Cityf State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Aiplicable' 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
that
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants 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 YOU111 LEN ER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
i
nature of jwnerr Lessee/Contractor as Agent for Owner
Signatu a of Contractor/License Holder
STATE OF FLOI�A•
I
STATE OF FLO �
COUNTY OF
COUNTY OF P rl, -Q
(
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of201-1"1 by
this t) day of SLL n.P_ 20 l`l by
//
�CtdZ JI-iIRK.PV-
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Name of person mak1inn statement.
Name of person ma kin tatement.
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pub ic tate of Florida)
(Signature of Notary Pu lic- tate of Florida )
Ir
Commission No. _���,C�pc,�10NEF198907
Commission NoDANYELJOPE an
'�°�� 3 f'"f a�g' �,:•p t� ^�4�
:xq.. '� hM1YCOMMISSION #FF198907
B
I1dt d7htu Notary Public Un
riter5
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