HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONY
1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION,TO BE ACCEPTED
Date:
Permit Number: _
- -- -- -- - _ - - - RECEIVED S(',AI
Building Permit ApplicatiorAR `0 12018 e
Planning an' dDevelopmentServices Fermittin partment St' LUCI
9 DeE!
Building and Code Regulation.Division ,.._„ - _ St. Lucie County '
2300 Virginia Avenue, Fort Pierce FL 34982 ._X{ ,
Phone: (772),462-1553, Fax: (772) 462-1578 Commercial_ . - _ Residential
PERMIT TYPE: -
PROPOSED IMPROVEMENT LOCATION.'
Address:
Property Tax ID #: ��.2 8- G 6 1 0 (� 6 06. 0 '- Q
Site Plan Name:
Project Name
Lot No.
Block No:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank, _Gas,Piping . _Shutters_'. '• =Windows/Doors. t
Electric _Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Coristrucfion: $ 1 '5700 Utilities: _ Sewer' -Septic'' ' Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name V, B to-4- 13_ AA C I R fie^
Name: C i C l e (�urnRcAk
Address: 3 2-1 9 -S U!l
Company:
City: rd Ci . ,. `..1.4.. •,:-.+,:•. + ; State: FL
Zip Code: 3-y9R?"" "NFaz:
•Phone.No: q_Li'b '= +9 9`6`
Address: n
City: Fd.1`�;_ I e; j•9; State: FL
zip Code: 3—
PfioneNo -%%2 -
E-Mail::•.�Cn��l.:,•��V,M uAC, C gMOI %dbt
Fill in fee simple Title Holder on next 'page if different '
from the Owner listed above)
_E_Mail
State or County License - C 13Oo S S ( 7
It value of construction is 5Z500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
SIMPLE TITLE HOLDER: Not
City:
Zip: Phone:
COMPANY: _Not Applicable.
Name:
Address:
City: ,
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.
Inconsideration 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 addit(ons,
accessory structures, swimming pools, fences, walls, signs; screen rooms and accessory uses to another non-residential use
"WARNINC 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."
Signature of Owner/ Lessee/Co6tractor as Agent for Owner
Signature of,Contractor/Li ense.Holder - -
STATE.OF FLORIDA
STATE OF FLORIDA`
COUNTYOF
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing'•in'strumentwas acknowledged before me
thisday of' . F2-(i 2019.;by
thisdayof20J!� by
Name of person making statement.
Name of person making statement.
Personally Known.%Z OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type'of Identification
Produced
Produced
(Signatureof Nota Public -State f Florida j
(Signature of Nota P r' "'
Notary Public Stale of Florida
Commission No. F Chris L(�i"ey
VOW
Commission No. Nolar($MpStateofFlorida
.+aG �• wcommissi. GG 165665
cw F_xpires 02/2612022
- - , Chris L Woolley
• My Commission
.
_ ..
qp xPWras 02/
022
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DATE
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DATE
COMPLETED
Rev. [/ r/ 19