HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO B UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-Date:— - Z.D-lq Permit Number
--
-- — ---- Building Permit Applicat on
Planning and Development Services BAN J 21)19
Building and Code Regulation Division Permitting Departmer
2300 Virginia Avenue, Fort Pierce FL 34981 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Res p'1_: ` Countyr FL
PERMIT TYPE:
1. S,
PROPOSED INPROVEMENT LOCATION: BY
Address: 5 ri
Property Tax ID #:
Site Plan Name:
Project Name:
S'e /
SLcds� Fine, 1 fOA 0L Lucie county
`-107 —313 — 00 15 000 Lot No.
r e l ri e/r Block No.
ence
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:.WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
t
Total Sq. Ft of Construction: ® 9r 1' nLca Sq. Ft. of First Floor:
Cost of Construction:$ A I600,� Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE;. ..'
CONTRACTOR:,;
Name 1 'S{'tn vL
Name:
Address: 17610 (OPL'h
OW'15Y
Md
Company:
City: Fork P), r, rc
Zip Code: 311 R Y 5 Fax:
Phone No. `7 7 2 — ZO I - O8 o C7
State: FL
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: +I )" e. fell n e h
Fill in fee simple Title Holder on next page ( if different'
from the owner listed above)
E-Mail
State or Cou License
If value of construction is $2500 or more, a RECORDED Notice of Commence ent is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement s required.
SUPPLEMENTAL CONSTRUCTIO LIEN LAW INFORMATION:
-DESIGNER/ENGINEER: _ Not Applicable—
Name:
MORTGAGE -COMPANY• = Not -Applicable_
Name:
Address:
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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDAC f
STATE OF
COUNTY OF GG/
COUNTY OFORIDA
The for oing instru t was acknowledged before me
this day of L� 204 by
The forgoing instrument was acknowledged before me
this _ day of . 20_ by
Name of person making statement.
Name of person making statement.
Personally Known R Produced Identification
Personally Known OR Produced Identification
Type of Id tification
Type of Identification
Prod
T6Z1_Ka&-4 Li
Produced
(Si nature of Notary u lic- Stag fY%Ida) SHERRI FEHLMAN
(Signature of Notary Public- State of Florida )
Commission # GG 187160
Commission No. Sea*lres March 14,2022
Commission No. (Seal)
OF RAP BmgW TW Budget Notary$mb,
REVIEWS
FRONT
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SUPERVISOR
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SEA TURTLE
MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev.9/26/18