HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFO MUST BE CON. , ;rED FOR APPLICATION TO BE ACCEPTED +
Date: b k Permit Number: c(o (� O
Building Permit Application RECEIVED
Planning and Development Services i JAN 2 8 7019
Building and Code Regulation Division permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. L OP e
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
SC I
PROPOSED INPROVEMENT;LOCATION: `" °_ a e: Y
Address: S S S 2 oS 13v07 cit. Lucie County
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
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: l Uo Sq. Ft. of First Floor:
Cost of Construction: $ Cl U Utilities: —Sewer —Septic
—Windows/Doors
R� oof /'L Pitch
Building Height:
OWNER/LESSEE x
€ONTRAGTOR:
NameSe_L)kvo
Name: h0
Address: ir! S All -of 0
Company: i tw
a o „e Co
City: PsL State:
Zip Code: 3 4 Fax:
Phone No.
Address:
City: ilk State: f C
Zip Code: Fax:
Phone No Z 33 ti
E-Mail:
Fill in fee simple Title Holder on neA page (if different
from the Owner listed above)
E-Mail 111f A�0 ".if 1PXie,11 � 4 D C t y
State or County License 30�1�)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPEMENTALCONSTftUTION 11IV.IAWINF?RMATIC}N,
,a$,.w,.;
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Contractor/License Holder
Signatur o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA C1 / ,.
�`T L-l.1_
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument cknowledged before me
this � day of —TA CJ 20-4 by
this�ay of rO@ . 20_Q by
Luo 0V%fccR o
`A AA 5 60yn; )VJ
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 ��
Produced
�/—
�j V UL�,�A' ✓
l�� V �Lff ��
(Signature of Notary Public- State of Florida)
(Signature of Notary Public -State 9f Florida )
Commission No. Seal)
Commission No.
�E66EN VAUGHN
ELLEN VAUGHN
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ii ommission #
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G 270079
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REVIEW
REVI
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/26/18