HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE I FO1MU{S/T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:I`Ir\ ` Permit Number.
SCANNEDBY
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St. Lucie County 16?019
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Building Permit Application St' e tent
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: Vl u q� bt a
Address: L)U O (-)
Property Tax ID #: 2140-- 56c-�- (113- Qor) ` Ci Lot No.
Site Plan Name: Block No.
Project Name:
'DETAILED DESCRIPTION OF WORK: •J
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric �lumbing _Sprinklers _Generator
Total Sq. Ft of Construct[ n:Sq. Ft. of First Floor:
U Cost of Construction: $ a)b Utilities: —Sewer _Septic
_ Windows/Doors
Roof Pitch
Building Height:
OWNER LESSEEa
CONTRACTOR:
Name
Name:
S -1
Address: f Q V
Company: \)
City: r State:
Zip Code: Fax:
Phone No.
Address:Ig5&6 - il, < �P
l�
ll�rU�
City: //
Zip Code: b Fax:
Phone N 1—
Stater
E-Mail: IJ 444
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail i
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.
SUPPLEMENTAL-00IVS71tUCTIDN,IIEN
_.
U#1N lNI OItMATiON,
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DESIGNER/ENGINEER:
Name
_Not
Applicable
MORTGAGE COMPANY:
Name:
NotAppllcable
Addr ss:
Address:
City: n �
Zip: Phone N
State:
City:
Phone:
State:
FEE SIMPLE TITLEHOLDER: _Not
Name:
Applicable
BONDING COMPANY:
Name:
_Not Applicable
Addressi
�1
Addre ��''
City:
-Zip: Phone:
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 holderto build the subject structure
which is in conflictwith 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 concurency 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 C0MMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB STIE BEFORE THE FIRST INSPECitON. IF YOU RYjllm TO OIfpNANCING, CONSULT
U \lS7dti1, 9
Signature of Owner/ Le Contractor as Agent for Owner
Holder
STATE OF FLORID STATE OF FLORIDI;(MIRS
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COUNTYOF�,�(Y�IfI[,IQ COUNTY OF 'sI�c
The forgoing inst ment was acknowledgeA before me
this la —day of 20by
Name of person making stat ment.
Personally Known OR Produced Identification
Type of Ident'fiption
Produced ft ,,
(Signature of ublic- State of Florida )
Commission
The forgoing inst ment was acknowledg before me
this (0 day of J r,,l . 20 by
%GSZI(-) A. l3 T-kICn
Name of person making statement.
Personally Known1OR Produced Identification
Type of Identification
Produced
Of
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