HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI_
F L O R 1 D A ---
Planning and Development Services
\D FOR APPLICATION TO BE ACCEPTED
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address: H LI 10
Property Tax ID #:
Site Plan Name:
Project Name:
Permit Number: L qol� b 553
RECE13 NED v BY
y�®
!AN 2 8 iolqucie Count}
Building Permit ApplicationPermittingDepartment
St, Lude CvunSy
Commercial Residential
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping ,_Shutters
—Electric —Plumbing _Sprinklers
Total Sq. Ft of Construction:
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
of Construction: $ Utilities: -Sewer _Septic Building Height:
OWNER/LESSE
OR
Name o 1z-,\LC
Name: t vvN 4
Address: ) D �t 0
Company:
V%; V 14
8 I
City: � 1 ✓w State: _
Zip Code: ---Fax:
Phone No. of a S) 33k
Addr_ess: SZ
City: OR SA- L ejc-,� 4 ) Stater
Zip Code: • 2H 90-J-- ddFax: •.- `i
Phone No' • O SJ
E-Mail:: L. d �Ci��C L 2 sC Q4tix.u.7-CLITN.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail IZ Q vY10�2 �i �' 9
State or County License 3ri�80
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.
W111 LIE,,-MEWiTfA'L]tC-PNSiTiRCiTiION 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF r ��'(�{CAP
COUNTY OF Sl— �L1C1
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of � 204 by
this _25day of Scin . 20_LJ by
L.L'is Recnarbir%('
(,c;,i s Rem of-�T)t
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 , F! DLL
'p,V4.Gt �—
Produced Ft_
I W
(Signature of Notafy Public- State of Florida)
(Signature of Notary Public- StatLf of Florida )
Commission No.
o„> ELLE GHN
Stets of Florida -Notary Public
Commission No.
;�,. •,, LLEN V 'UGHN
`eS State of Floritla=Notary
=• =
' •iiPub'
?
y Commission
Expires
�� .s;:�
My Commis I
n20
0079
REVIEWS
l
22 --
PER
OR
PLANS
VE
yr
N OVE
RE
COUNTER
REVIEW
REVIEW
W
DATE
RECEIVED
DATE
COMPLETED
Kev.9/26/18