HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO IMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�!^, ^ r
Date: "I r p — R Permit Number: 130' t/ 02 V�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579
PERMIT,TYPE:
SCANNED RECEIVED
BY
St. Lucie County APR 0 8 2018
Building Permit Application P®rmltting oepartment St. Lucie County
Commercial
Address: SJoCtS l//he�1-iraJ.-Q1 hauw4L uroA-�
PropeityTax ID #: OO Q0�4 CiOC9 — in
Site Plan Name:
1
Project Name: �aubn n
TION'OF WORK
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: Sq. Ft. of First Floor: _
Cost of Construction: $ / 5 o O
Residential ✓
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OVVNEIVLESSEE:. a
-CONTRACTOR:
Name 5c.
Name:
Address: P I cm
Company:
►�
City: c `� Stater
Zip Code: i7 D / T Fax:
Phone No.
Address:Sf` , Aw rrirr,n
City: 91,. S�— L'i c.tx.
Zip Code: %L6Ct1r 3 Fax:
Phone No n72 626 gVltS
State: FL -
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �'rr..v1 g As Ec-
S
,(A
State or County License % / / V
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 orore, a RECORDED Notice of Commencement is required.
I/
SUPPLEMENTAL CONSTRUCTION LIEN LAWINF.ORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
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."
Signa essee/Contractor as Agent for Owner
r+—a of Contrac 5/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF ldACAL
T�
COUNTY OF cl
The forgoing instrument was acknowledge efore me
Th going instrument was acknowledged before me
this day of 20by
L�s
this day ofnP 20��jby
om Zd ou n I
Name of perso making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati
Type of Identificatio //
Produced i
Produced Z)�
le u
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(Signature of
o P r c-Sate of Florida
(Signature of N Public- Sta f Florida)
Commission N
:ipY>L''o ELLEN V 4GHN
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Commission No a'-- ELLEN VA
a Commission N GG 270079
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DATE
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Rev.2/771'!