HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL i CD FOR APPLICATION TO BE ACCEPTED 2
Date: "241 ) 4 Permit Number: ® C-) 3 J
SCANNED
BY
St. Lucie County''
Building Permit Appi
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: #
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Permitting Department
;eEiihebtloleTounty, FL
Address: ok l a,) z, C— l.F. It J G-.c -e�r-\ )f", r C,�,A— `)i6 N-'?
Property Tax lD#:!% �SrON -%m OD03-U00-5-- Lot No.
Site Plan Name:
Project Name:
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank _Gas Piping _Shutters
°Electric mbing _Sprinklers _Generator
Total Sq. Ft of Construction: Gd L y Sq. Ft. of First Floor:
daa
Cost of Construction: $ r Utilities: —Sewer _Septic
Block No.
Windows/Doors
Roof Pitch
Building Height:
OWNERJLE55EE„ ! '
`„'
CONTRA�fQR:
t ?,
Name
Name:
Address: u,c
w� P
Company:
City:
Zip Codesa� G S �_ r Fax:
Phone Nonce % a -3lo t D(o
StateF
/
Address:
City: State:_
Zip Code: Fax:
PhoneNo7;:.._..
E-Mail:�,G�-W
Fill in fee simple Title Holder on ne)d
from the Owner listed above)
page (if different
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.
SU.-LEINIENTALCONSTR#
GTION Ll(NRI.AW IN
pRMATiON , �'
` • °A
DESIGNER/ENGINEER: —Not Applicable
Name: r� ��L �e ��P r.
MORTGAGE COMPANY:•
Name:
_ Not Applicable
Address:
Address:
City: ® State"
Zip: ow Phonem-%- :-JC-5c)
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 tlfe 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
"YARNING 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."
S'gne�of}0,�/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA pp � f
STATE OF FLORIDA
COUNTY OF �d l.Cf%�—
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this t—day of. 20 by
this_ day of 20_ by -
D on-E, 2:-olnnntc,hnn
Name of person making statement.
Name of person making staterrrent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced
Type of Identification
Produced
fFL
(Signature of Notary Public - St a of Florida)
(Signature of Notary Public- State of Florida )
Commission No.��% j.,, ELLENV
State of Florida-
Q�gmj'%1 No. (Seal)
otery Pu m
JJ s,
,� Commission 0
00 270079
'"'°I�+��
October
2, 2032
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DATE
RECEIVED
DATE
COMPLETED
Kev. 211119
SCANNED
BY
St. Lucie Countv