HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf -�
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^ D2 Q r
Date: I �- 1 Permit Number.
RECEIVE®
-- —. Building Permit Applica ion FEB 19 2019
Planning and Development Services Permitting Department
Building -and Code Regulation Division _St. Lucie -Count FL
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
;PROP�OSED�IMPROUEMENT LOCATIQNa _
Address orl
Property Tax ID #:
hs-nr)C!)H - rv-)n) Lot No.
Site Plan Name: Block No.
Project Name: �12`k�11D1
DETAEROOrxi
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GONS�TLRUC�f1ON INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank Piping
_Gas _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator <—R6of 4hz� Pitch
Total Sq. Ft of Construction: , �TT� Sq. Ft. of First Floor:
�nd�
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
,
aOWN' ER'/LiESSEE:
CONTRACTOR:
Name i
Name:__ 1 .LL
Address:
Company: r C�-C-Vk\ 2i
City: P.C. State:
Addr'es]; :
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Zip Code: ) bq Fax:
City: t'( e�1 �. State.
Phone No.
Zip Code: acpq!L c�r Fax:
E-Mail:
Phone No -
Fill in fee simple Title Holder on next page (if different
E-Mail l r C
State or County License s
from the Owner listed above)
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.
Sl'J PL�EIVIENTALCONRU�CTION LIEN L'AW I��NFftATI
SON n�� f d
A _ _
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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'S—igntftdre of Owner/ resspV7Contractor as Agent for Owner
gnature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLO
COUNTY OF� • �l (1w �_
COUNTY OF - LU
The for oing instru�n ntwas acknowled ed before me
this)dayof 2� by
The for oing instr t was acknowledg efore me
this day of O�by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced IderitificatiolL
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
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Produced
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Signature of Nota Public -State of Florida)
ature of Notary Public -State of Florida )
Commission No. S��y}��eerPuoilosateatFb
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Co 'fission No. d' Seal wy Public sate of Fr
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Amanda P Sandersoi
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