HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE NFO MUST BE COMPLu cd FOR APPLICATION TO BE ACCEPTED Date: Permit Number: I c(ryy 0r' N
RECfIVfp
APR O R 10/0
SCANNED
Perm 1
Building Permit A004'ant BY
Planning and Development Services unit St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address: - J I t-J Id i I Y 11
Property Tax ID #• J Lot No
Site Plan Name: Block No.,�_
Project Name: rTr I I V1 nQ h FQ I CYCi
DETAILED DESCRIPTION OF,WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/
Do'o�rs
_Electric _Plumb' g�� n. SpCinklers _Generator Roof _0ZPitch
Total Sq. Ft of Construction: CJ0 — Sq. Ft. of First Floor: 3`30C�
Cost of Construction:$ 1-7955-00 Utilities: _Sewer _Septic Building Height: is
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company:
City: C) State:
Zip Code: Fax: (±
Phone No. �71 —I
Address: 01
City: ��ti Stater
Zip Code: Fax:
Phone No Z 2
p
E-Mail: �- I� tn, o
Fill in fee simple Title Hoider 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.
SUPPLEMENTALCONSTRUCTION 'LIEN LAW INFORMAT,10
MORTGAGE COMPANY: _ Not Applicable
Address: I Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Address: Address:
City: City:_
Zip: Phone: Zp
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit To ao me wurrc cams H
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 1 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
improv,Knents to your property. A Notice of Commencement must be recorded and posted on the jobsite
before tt a first inspection. If you intend to obtain financing, consult with lender or an attorney before
Comm In WU"[ULUJU rr Vur INVU,, V
nnnnor 0
Sig ure of Owntractor as Agent Owner
Signature of Contractor/License Holder
STATE OF FLORID
COUNTY OF I UcIL
STATE OF FLORIDA 1
COUNTY OF
The far Dinginstrum to �s,anowledg-rAhefore me
this day of Tj 1/ ICI_ I , 2d_ by
The for Dinginstr tw s acknowledgerNyby efore me
this day of 20f� by
awn on na
Q I� � 1 lti
Na a of person makingstatement.
Personally Known OR Produced Identification
Type of Identification
Produced
Name of person making statement. J
Personally Known N OR Produced Identification
Type of Identification
Produced
(S)SnatTrezqNiAa Ic- State
�1�
Commission N lY 4V
1'
ig ature of Notary Public- St
mmission N C
4er+E} KATHERINE HAVENS
eipr'o°c p��{.�
r o N`1mISSION #GG765030
- DEC 04, 2021
o, •�"gym KATHERINE HAVENS
+- (BeHIj COMMISSION #GG1650
I
'� EXPIRES: DEC 04, 2021
Bonded Ihrouch tat State Insure
ce
E%pIRES�
Bonded through 1st State Insurance
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