HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONb
All APPLICABLE INFO MUST BE COMPLETCU rOR APPLICATION TO BE ACCEPTED
Date: \ $ Permit Number: yzC1 N4.3
IL,quLMIMIL-M�
-- '--•—_ JAN 08 "019
-- — — Building Permit Applica ion ED
Planning and Development Services ST. Lucie County, Per i
Building and Code Regulation Division St. Lucie Cour
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential iC�7
PERMITTYPE:
hP'...ROPOSFD'INPROVFMFNT tOCAT10N: ,; , `. ' ".'I
Address: //Vo7 z Q"rrl1"J KCA-
Property Tax ID#: eao O\tip- 406-4
Lot No.
Site Plan Name: Block No.
Project Name:
GONSTRU'CTION, INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /O ti Utilities: —Sewer _Septic Building Height:
OWNER%LESSEE.>'z°fp
CONTRACTOR:
Nam p?
Name:
Address: 39
Company;
City )a Stater
Zip Code_�3 Fax:
Phone No.::_�! W, V 1/. 3.,LI%
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:.
Fill in fe simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requrea.
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
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 lender or an attorney before
commencing work or recording vour Notice of Commencement.
gnature of Owner/ Lessee/Contractor as Ag nt or Owner
Signature of Contractor/License Holder
STATE OF FLCI IpA
SS �?FF �-�
STATE OF FLORIDA
COUNTY OF • c t
COUNTY OF
The forgoing instr�ur ent was acknowledged before me
-J
The forgoing instrument was acknowledged before me
this day of 4J\ 20\� by
this _ day of 20_ by
5cy"�\ Cn6,-IV
Name of person making statement. J
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identiflicati n
,�"L L
Type of Identification
Produced
Produced
(Signature of Notary Pu c- St s
(Signature of Notary Public- State of Florida )
oEnNNp oNl� Go2202s '
Commission No. , •a'�(coull� an to 2020
Commission No. (Seal)
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.