HomeMy WebLinkAboutappAll APPL ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n I _ Q - I
Date: Permit Number: {I
RECEIVE
� AUG 01 2019
Building Permit Applicati T.LuciUG 01,Permitting
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 _ Residential
PropertyTaxlD#: , \3i'�O)—O��q_aao-y Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
_ Gas Tank
Plumbing
_ Gas Piping
Total Sq. Ft of Constructio,.. tvOtO ' a
Cost of Construction: $ . 1. r7
Sprinklers
_ Shutters
Generator
.. Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height: 8
Address:
�ZlO� V�Afaty�2A5 /il/C
City:FQI f State:F—-L,
Zip Code: 2)41 6) `, Fax:
Phone No. '?% Z - Y 0 1 - '37- 09
Name:
Company:
Address:
City:
Zip Code:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
Fax:
State:_
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
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
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
"WARNNG 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."
X A4 Too L' ("L, d
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sir, L.-owR,
COUNTYOF
The forgoing instrument was acknowledge before me
thisdA day of c5 J� 20 by
The forgoing instrument was acknowledged before me
this day of , 20_ by
�.q rrre h Caer�T-a
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 V L
Produced
(Signature of Not
=NA! IE GIVENS.
Commission No. �, 1Y COMldI IO, #beGG 022023
XPIRES: r16,2020
Bmded Thm Nalary PUUr Ul`IaW'tam
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
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