HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO\ MUST BE COMPLES zw iOR APPLICATION TO BE ACCEPTED
Date: �1� i � \� Permit Number: VgC),av pu
s a ;
REcEryEO
Building Permit Application
MAR 01 2818
— Planning and Development Services
Permitt.
ulation Division
Building
st Lag
2300Vi ginia Avenue9FortP'erce FL 34982
"Unty nt
Phone:.(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
A
PERMIT TYPE:
SCANNED
RV
PROPOSED IMPRMOM panLOmON:
St. L cie D
1 `
Address: L�
PropertyTaxlD#: 2�01
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
Tota]r q f_Cd5rstru t of n`g _qg Sq. Ft. of First Floor:_
Cos O coiistr[rctjo Utilities: _Sewer _Septic
_ Wind ows/DPors
Roof
Building Height:
OWNER/LESSEE:
CONTRAGTOJR?
Name
Name:
Address:
Company:
\ l�
City:
Zip Code: Fax:
Phone No. Mai, 930 3 �
State:
Address:
City: State:_
Zip Code: Fax:
hone No,: 4"
E-Mail: 5�k
Fill in fee simple Title Holder on next page ( if different
-from the Owner listed above) — _
;.E Mall
State or County.Ctcense = s -
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.
SUP LR TLC NS ff+?N EN LAW INF+RNIRT • '.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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 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
pp
BE RECORDED AND YOUR PROPERTY. ON THE NOTICE SITEOBEFORE ITHET FIRST
INSPECTION YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR
LENDER OR' ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COM ENCEME
Sig atu of Owner/ Lessee/Contractor a or Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrLKn_ent was acknowledged before me
The forgoing instrument was acknowledged before me
this day�o of V-Q2011 by
this _ day of . 20_ by
anh� U31os\-4n c\
Name of person making statement.
_
Name of person making statement.
Personally Knowny OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ign ture of Notary Public- State of Florida)
(Signature of Notary Public -State of Florida )
..Commission No. ••; ••.
�
mmission No. (Seal)
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