HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CC , • LETED FOR APPLICATION TO BE ACCEPT'2v
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address:
RECEIVED
Building Permit Applicat on MAR 19 W9
SCANNED ST. Lucie County, Permitting
BY
St. Lucie County
Commercial Residential
Property Tax ID#: 4S1(--5-G'O—OCJS;iAV ^fp00^C(
Site Plan Name
Project Name:
°DETAILED DESCRIPTION'OF WORK:;' ITY:• n
CONSTRUCTION INFORMATION . :''
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: I)
Cost of Construction: $
Sq. Ft. of First.Floor:
Lot No. Z7
-Windows/ oors
Roof �C `7� Pitch
Utilities: _Sewer _Septic Building Height: �—
`OWNER/LESSEE:
" :
;•CONTRACTOR:,
Name —
Name:
Address:
Company:
City: , State:
Zip Coc!OA! '✓ l Fax:
Phone No.
Address: ��"Ze�c� �r� Q✓i
City: (ZJ.
Zip Code3S' Fax:
Phone No "L'777--^ 34Q
State:IEL-
—
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
^`Z735
State or County License
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.
JEUIAWIN
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
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
WIVU vn"n I ENDVR no Atu ArrnDNFY RFFnPF RFrnROING YOUR NOTICE OF COMMENCEMENT."
Signatu ' of ironer/ Lessee/Contractor as ent for Owner
Signature of Contra or/Lifense H Id
rl
STATE OF FLORI
STATE OF FLORIDA pp
COUNTYOF .)C It_
L
COUNTY OF .• ,)QrIF
The fo oing instr ent w s acknowledg before me
this � day of 20,� by
The f oing instrument wa acknowledge before me
this 4 IIIday of 20_A by
rYU ° tl�NAAArrq
Ofl(V
Name o per on making s afement.
Name of person ma ing�ment.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica ' n
Type of Identific 'err
Produced
Produced
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(Sig lure of Notary Pub l
S F S. NIELSEN
Signature o Public -State of Florida )
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