HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y vs SCANNED Permit Number: `\o`1-a3� 1
BY :REC
EIVED
St. Lucie County
Building Permit ApplicatiEn1620)9Planning and Development Servicesgeinty, P4rfnlFcipg
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMITTYPE: e O
Q,
PROPOSED INPROVEMENT:LOCATION:
Address: ��/�
Property Tax ID #: 2 5 - W - . 8 Lot No.�
Site Plan Name: Block No.
Project Name:
DETAILED -DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ / Plumbing _ Sprinklers _ Generator 4 Roof
Z Pitch
Total Sq. Ft of Construction: iq oo Sq. Ft. of First Floor: 000
Cost of Construction: $ , OQ Utilities: _ Sewer _ Septic Building Height: 15
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Fill in fee simple Title • •.. from the Owner listed above)
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: CONSTRUCTION LIEN LAW INFORMATION: •-
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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, 1 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 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
commencing work recording our Notice of Commencement.
for
/-moo (D�r -'L
ILiPA f-I
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA nI
STATE OF FLORIp
COUNTY OF `,T- ! I U0
'
COUNTY OF�_j UC'
The f in inst u as acknowled efore me
thisifdayof 20'D
The f oing instru as knowledg efore me
this day of Y 20 by
o (Ient
Ji
Nalne of person makingstatement.
Na a of person making aakatement.
/
Personally Known v OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
CwTf A�
(Si a e o t ublic-
o1N.r v oG I THERINE HAVENS
Commission � ° N �4TISSICN#GG165030
f� ES: DEC 04, 2021
Bonded through lst State Insurance
(' re otary Public- State of Florida
//r�//1l]),, ,.wY"DBc �i(ATHERINE HAVENS
Commission Nb� _{/�y�y ibMMISSION #GG7650
`�,�r`-- °?R!T7ftMr EXPIRES: DEC 04,2021
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