HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a \q Permit Number:
SCANNED
BY RECELVED
St. Lucie County
Building Permit Application FEe 152019
Planning and Development Services Permitting De
Building and Code Regulation Division st. Lucte covrtyent
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1/
PERMIT TYPE:
Address: 'on 0. 1�1L� n5 1{ cJ
PropertyTaxlD#: �3�3-►ll-oOlo-OOo -I
Site Plan Name: �to2lae l RaS� c�er�c 2 CAYL(brt�
Project Name:
Lot No.
Block No.
CONSTRUCTIO.N,INFORMATION ; L - I
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: `!' 50 -Sq. Ft: offirst Floor:
zygo
Cost of Construction: $ -SJ Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height: is F�
OWNER/LESSEE:
CO.
NTRACTOR `- -
Name Rhvtws,.t G_ Ac�e)ae�
Name:
Address: \\51c, S_ T4u ALNRZ, Qa
Company:
City: Vron-k PtcscJz_ State: FL
Zip Code: �4q�1- Fax:
Phone No. '1-1- LAb- -1 aa. is
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: b �'(`02. (odd l*1Je , G,, tA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
it value oT construcnon is $zsu :"pre, a RECORDED Notice of Commencement is required.If value of HVAC is $7,500 or mores RECORDED Notice of Commencement is required.
'5UPPLEMENTAL,CON5TRUCTIQN LIEN ,LAW INFORMATIONu
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 bylaws
rules, 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER DR AN ATTORNEY BEFORE 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 . ,. , a COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this V57 day of pb ,26 6 by this _ day of . 20_ by
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
(Slgeature of Notary Public- State of Florida) MIN
ignature of Notary Public -State of Florida)
1NGRpN,•
Commission No. ,.•••'. ; 27
C mission No. (Seal)
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