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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED' - q Q `` Permit Number: \ L04 , V 300 SCANNED Building Permit Application BY St. Lucie County Date: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: Address: / Z/ D !J' a Jg Property Tax ID #: �zj - l O -Site Plan Name: A A u 40 'S d M Project Name: IQ G, C/- e d S t^ Commercial b Cs©a5�- oa Residential Lot No. Block No. Additional work to be performed under this permit- check all that apply: -&,tl(echanical _Gaas�sTank _Gas Piping _Shutters —Windows/Doors Electric L iumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ ���® C Utilities: _Sewer _Septic Building Height: OWNERjLES5EE: +r' = I. CONTRACTOR: R Name ,n 7-A a n �?l a. �.. v LY• s o c Name 11,4 % All 46 � ✓ Address % lll� ln) SOq LCIA,t Company: M I e one ✓ S City.kfg) k Stater• Zip Code:Yq �q Fax: Phone No. -la- Scl-C17ri Address: )D City. R1 ccc1e State: Zip Code,'�7`/icl% Fax: Phone No 1�i72-U�R'7CoCC`l E-Meil:�� %`c�Chn ��fi�lR+Q• COM Fill in fee:simple Title Holder on next page ( if different from the Owner listed above) E-Mail i9''a State or County LicenseAd�l leis 9 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. C Ue01urverc/MU1MM _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: BONDING COMPANY: _Not Applicable Address: Zip: 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before comrprencing work or recording our Notice of Commencement. ' nature .(rm i/@L'essee ontractor as Agent for Owner gn`a3�re of` iactoJliceitse:Holdec STATE OF FLORID STATE OF FLORIDA COUNTY OF_ G Lu ✓cL COUNTY OF S� Lulu, Y The forgoing instrument was acknowledged efore I me The forgoing instrument was acknowledged before me this I day of 20by this day of �/L 204 by Y `� i2 , i'J G �C! (sl �,�%/.f ( n n/ � � 6t /LIB /m/ Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced D/—, U n (Signature of Notary Public- St of Florida) O¢ 3 (Sign ture of Notary Public- SWe of Florida) ? p a q Commission No. (Seal) jz0 om Commission No. (Seal) y L �° z m:� ¢V COIT t mZ��O REVIEWS FRONT ZONING 71 2LL E2 R PLANS VEGETATION SEATURTLE M Q_�C.H` COUNTER REVIEW f¢�l�LL REVIEW REVIEW REVIEW