HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLI ,ABL
Date:
INFO MUST BE CO[ �Ji -FETED FOR APPLICATION TO BE ACCEPTE V ' �p
Z • �' SCANNED Permit Number:
sly
Plannin and Development Services
Buik and Code Regulation Division
2300 Vi ' inia Avenue, Fort Pierce FL 34982
Phone. (772) 462-1553 Fax: (772) 462-1578
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Building Permit Application Lt:- ® 6 ; ,,j,o
ST. Lucie County, Perm:' inn
Commercial- Residential
PERIV
T TYPE:
RROP
j SED IMP:ROUEMENTLOCATION ,
I,C`ONTRUCTION INFORMATION:
Additio" al work to be performed under this permit —check all that apply:
i
echanical _ Gas Tank _ Gas Piping _ Shutters
✓ ectric ✓plumbing _ Sprinklers L _ Generator
Total S . Ft of Construction: Sq. Ft. of First Floor:
I
Cost of, Construction: $ Utilities: _ Sewer ✓Septic
G-Windows/Doors
Roof Pitch
Building Height:
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;'CONTRACTOR
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City:
Zip
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Name:
Companyjt—t Ar'P r 44
Address: / 7-20 t� ,0174,w r SLVv
ss:.35903 EEik° Ale 80061
lemp State: FL
de: 3ygs7' Fax:
6 No.
City: lc / etc I Stater
Zip Code: 39 %V5 Fax:
PhoneNP,
E-Mail
State or County License (°�(' j5o?6JC/
ll:
'fee simple Title Holder on next page ( if different
,the Owner listed above)
it vaiu or construction is SZ5o0 or more, a RECORDED Notice of Commencement is required.
If valu of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPL
77.
MENTAL CONSTR ON LIEN LAW INFOrRMATION
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DESIGh
Not Applicable
R/ENGINEER: pp
MORTGAGE COMPANY: _ Not Applicable
Nam
Name.
:
Address:
Add res
State:
City: State:
City:
Zip:
Phone
Zip: Phone:
FEE SI
�PLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Addres
:
Address:
City:
City:
Phone:
Zip: Phone:
Zip:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify tat no work or installation has commenced prior to the issuance of a permit.
St. Lucie unto makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is i conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.' lease consult with your Home Owners Association ,and review your deed for any restrictions which may apply.
In consid ation of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accord ce with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follo ing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory tructures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNI G TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWI JE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POS ED O THE JOB SITE E THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT YQIRENDER OR ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
A q/ 1:T1 __r
✓ner/ Leee/Coiitrdctor as Agent for Owner
STATE gOF FLORIDA
COUNTY OF
The for ding instr ent was acknowledged before me
this 3 day of s 20_ffl by
Name f person making statement.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 4 � . 1,L& � e..
The forgoing instr ment was acknowledged before me
this ay of v.. Lo-s 201-!S by
Dew
Name of person making statement.
Person ;Ily Known OR Produced Identificationy Personally Known OR Produced Identification
Type o Identificatio Type of Identificat''Qn
Produced Produced 1,J L_
(Signs re of Notary Public- State of Florida )
Commi Sion No. G 1 2n (Seal)
REVI
DATE
RECEI
CJAL<J�
(Signature of Notary ublic- State of Florida )
Commission No. G& 2 $? 7 2 9 (Seal)
EWOR I REVIEW JMC,,�
LANS + @�AIEW I REVIEW �IVIANGROVE