HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMI-LcicD FOR APPLICATION TO BE
Date:
ACCEPTED
Permit Number: O ot
RECEIVED.
■
APR 0 5 1010
IWO Building Permit Application
Planning and Development Services
Permitting oe,,a,,rnent
St. Lucrecounty
Building and Code Regulation Division
SCANNED
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578 Commercial
BY
ResidentialLicie Cour
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION,", 'w
"s
Address: 7 ;73 A IPI? /,Ov) /7 1/'1,1'7_h 1341
Property Tax ID #: 0 3q 1q—
56—
c)) L)
Lot No.
Site Plan Name:
Block No.
Project Name: S17 A5,12
Dt-rAiLED'DESC'klPTl'ON.=-OF ORK:
y.,
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank Gas Piping Shutters
W_
Windows/Doors
%r'l! ctric Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Constructiog: Sq. Ft. of First Floor:
-V Utilities: Sewer Septic Building Height:
Cost of Construction:$ of/ogods
W
OWNER/LESSEE: o
CIONTRAGTCIR:�_ %
Name
Name;
Address&U3
Company:
City: 40 �tat��
Zip CodetV4/5?&9 Fax:
Phone N o. A / ' 3 - W1 -Z��r
Address:
City: State: —
Zip Code: Fax:
Phone No
E-Mail:k,ICI�a V,611W_OV62&4-11P
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.
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SUPPLEMENTAL COOm f i 1CTION, LIEN I INFORMATION.
i3 k i>T '`�, `t
DESIGNER/ENGINEER: _ Not Applicable
Name: f
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: ok
Address:
City: , State: A_
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of . 20_ by
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
r
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal) f.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
nev. 2/7/19