HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETLu eOR APPLICATION TO BE ACCEPTED
Date: /- % / % Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
JAN 0 7 20,19
Building Permit Applic '.Q,neGoant9A
St. Lucie County
Commercial Residential ""0'
PERMITTYPE: AeS;0,00 t I 'k 14Ap,4%rJ?q
PROPOSED. INPROVEMENT LOCATION:
Address: `% /`I ('4m 1 eit?'%Q
Property Tax ID q: �b' /3" s®a - �l �7 - 0 2i� S Lot .43
Site Plan Name: ST U�U% Block No.
Project Name: S77—AL/1HT
DETAILED. DESCRIPTION OF WORK: ^
CONSTRUCTION, INFORMATION: r
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 136D Sq. Ft. of First Floor: _
Cost of Construction: $ q0 ) 0() 7 Utilities: -Sewer _Septic
_ Windows/Doors
V'Roof Pitch
Building Height: 15-
OWNER/CESSEEt
CONTRACTOR:
Name
Name: r Ic
2Cs'g
Address: L Jo Y -erg
Company: Y
- l�G =
City: Tax- �P1 -Q State: (,
Zip Code: 7249,z 1 Fax:
Phone No. 91' — 3bS
Address: _`3k S ► s
Akcih 4) e r
City: G °
Zip Code: InC 2
Phone No%7Z- 3(0/.-%0S1(0
Stag
Fax: Z2Z-3&/-6-Z
E-Mail: bs':6LhA�
�Cnyalq;(rt)/)
Fill in fee simple Title Holder onWext page ( if different
from the Owner listed above)
E-Mail ( a rn� ►4/\
State or County Licensee
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.
- —
SUPPLEMENTAL;CONSTRUCTIO N LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: I State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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
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 jobsite
before the first inspection. If you intend to obtain financing, consult with er or an attorney before
commencin or recording our Notice of Commencement
Sign ture of Owner/ Les a/Contractor as Agent for Owner
Sign ture of Contractor ' ense Holder
STATE OF FLORIpPA
COUNTY OF
STATE OF Fl.otnA l pi
COUNTY OF
The forgoing instrument was acknowledgebefore me
this \ day of-dd r\ 20 by
The forgoing instrument was acknowledged before me
this _�_ day of Zlzk f\_ 204 by
L q c i.$ iJAsi'Sr<
La rty 'A AL 6e
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi ation
Producedl. fl L
Type of Identification
Produced "F— L Q
(Signature of Notary blic-State of Florid EG tz s
Commission NO. ., �020
SOao 00202�q?:."�bef
ZIP", rtbe�t ero
:. PlPE9N puCricUnda^un
(Signature of No 'ram Bt®g)SIPh SSIof eG0
Commission No. 1Urdenwdwn,.
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