HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL�� 2J FOR APPLICATION TO BE ACCEPTED
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Date: — L Permit Number:
r
IRR�i RAM RECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
MAR 0 7 2919 ,
-Building. Permit Applicationrmittogoe -
- St. Lucie county
PERMITTYPE:
PrO000SED I M— P �R W, E M E N IN ME) ATI(3N:
Address:
Commercial Residential
Property Tax ID #: 23 e — �a �$— �� — Lot No.-9
Site Plan Name: t>�sr� Block No. Q
Project Name: k %-�
:tea Fi�7���s=��.a►���
BY
Additional work to be performed under this permit- check all that apply: St. Lucie Cow
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/D or
Electric _ Plumbing _ Sprinklers _ Generator oof \�Pitch
Total Sq. Ft of Construction: 1 J Z O62 Sq. Ft. of First Floor: C l� /
Cost of Construction: $ w . CPO C> — Utilities: —Sewer _Septic Building Height: A !;
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:Ok ta2c=zz2 "tLm� �i/.�
Company:
/�r� �s State: _
Zip Code � � Fax:
Phone No.
Address:^
City �`�TJ Stated.
ZipCodG��f7 Fax:
Phone No'�`
-E-Mail: - -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License e7e --A-y-2
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.
MT. PPL E M E NT L CONSTR ON UEN LAW INFORMgT
0
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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/ Les Contractor t for Owner
Signat o for 'cense Holder
STATE OF FLORIDA ,j�
COUNTY OF Sl C.IS�
STATE OF FLORIDA
COUNTY OF
The for ng instrumen was ac gowledge before me
this day of 20 Q by
The forgoing instrument wascknowledge efore me
this day of 20_Q by
atn, £r�P
jl a Q,
Name'bf person ma ing statement.
Name of person 6faking stateme
Personally Known OR Produced Identification
Personally Known OR Produced Identification f
Type of Identificatio
Type of Identification �
Produced���D(i
j J
Produced /mo o '( —L
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- Sta f to ida
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Commission No. °Ge., (SPE EN VAUGHN
`r;_SWB`of
"" LLEN VAUGH
ommission No. "PY°`a0
'� k=� f Florida -Notary
_'� Florida-Notery Publi
y E Commission #
= Commission # GG 270
?sc M
40 ` YOoo
m`ssiOn Expires
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October 22, 2022
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