HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL • INF MUST BE COMPLY fJ FOR APPLICATION TO BE ACCEPTED
Date: SCANNE® Permit Number:
_ BY
- NO
St. Lucie County aEcelvEo
s
21p19
B1ildingl Per dt.Application nt
PR °
Planning and Development Services (� 1/ry1y a�Jb�`'�`- Petmtttive C u �'
Building and Code Regulation Division \ St. w
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �_
PERMIT
Address: iG fi O
Property Tax ID #: I So/- tall- 08W ^ 000-0 Lot No.
Site Plan Name:
Project Name: --::) g V--ike,41/F>'C'te
Additional work to be performed under this permit -check all that apply:
Block No.
_Mechanical _ Gas Tank —Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
f�lj dG
Cost of Construction:i��%
L
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNE-R/LESSj E:
CONTRACTOR:
Nam &+ev 1V 31rory �✓
Name:
r
n
Address:IOI%
Company:
City:{;.!State:
Zip Cade: Fax y
Phone No.Code
Address:�7��ih�f�9/Y
--
yCity
may'
,PhoneNo
Fax
Stater
E-Mail
Fill in fee simple Title Holder on next page ( if different,
from the Owner listed above)
E-Mail lJpcl/=/f ao�• cow
State or County Licensed Aga- / 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.
SUPPLEMETA GONSTR ON LIEN LAW INFORMATIQN.
IN, 10
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 IMPROVEMENTS ToOPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
PO ON HE JOB RST INSPECTION. IF I END T TAI FINANCING, CONSULT
WNEY
,,WITH YOUR NDE R AORE RECORDING RNO ICE CO ENT "
i r f Owe es Contractor as Agent for Owner
rte
natu C nt or/ " en Holder
ST LORI
STATE F FLORI
COUNTY �.n
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this_ day of 20_ by
r� �
Name of person making s atement.
Name of person maki statement.
�OR
Personally Known � OR Produced Identification
Personally Known Produced Identification
Type of Identification Produced
Type of Identification
•�
Produced
gnature of Notary Pu c- State of Florida )
Commission
(SWtuX of Notary Public- ate of Florida)
Commission No. (Seal)
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Rev 2/7/19