HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MAST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '/T/C/ % 9 Permit Number: 1 -1
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Property Tax ID #:
SCANNED RECEIVED
BY
St. Lucie County APR 0 2 2019
Building Permit Applicati n
ST. Lucie Coanty, P�rmltting
Commercial Residential
-000
Lot No.
Site Plan Name: Block No.
Project Name: �A/k rl n (
Additional'Wo'rk to be performed under this permit - check alKthat'appyi'
`
43vlechaojcal
Gas Tank Gas Piping .Shutters
'�"Electric
_
Plumbing Sprinklers iGenerator
Total:Sq..F:tof.Construction:
4W Sq(`l Ft.�of First Floor:_
Cost of Construction:
$—f6�v .5-OD Utilities: _Sew`er _Septic
_ Windows/Doors
-91100f, . ' W' /,�)Pitch
Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name l .
Name:
Address. U /iy� c5�,.
Company:
City: A J Statetn/1
Zip Code: Fax:
Phone No. V
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: � /r/
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
Name
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Address:
Zip:
Phon
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
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. '
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
POSTE TJ'IE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH RXENB€R O�AN AJTOR5119Y 5MRE RECORDING YOUR NOTICE OF COMMENCEMENT."
'Signature of Contractor/License Holder
,.....•.
'S e off3wnef see actor as gent a
i!:
'•oSuAP
STATE OF FLORIDA
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ST OF FLORIDA
COUNTY
COUN OF
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forgoing befor+
The for oing i trument was ack wledge before
T day 2019by
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The instrument was acknowledg
this day L 20 by
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this
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.
177
Name of person makin t ment.
m
Name of person making statement.
yT
Personally Known OR Pr uced Ident cat
Personally Known OR Produced Identifica /
Type of Identifica 'on Produce
Type of Ide!Ution
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1
Produced I fl •
//
(Signatur of Notary P lic-State of Florida )
Com fission No. (Seal)
(Signature of No Public- State of Florida)
Commission No. (Seal)
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DATE
RECEIVEDDATE
COMPLETED
Rev 2/7/19