HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETtu'rOR APPLICATION TO BE ACCEPTED
Date: 1, 6Permit Number: Y�6CP+-d3��
SCANNED
_ BY RECEI`JED -
St. Lucie County
APR 15 --31
--- -- Building Permit Application
Planning and Development Services ST. Lucia CC�r, Fermittjnr
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Y
PERMIT TYPE: I
PROPOSED IMPROVEMENT LOCATION:
[teiicires''s SL0A�9 20
Fo ertyJax.lq4:-7y04�-Cog-01Cs-onb-C' Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
'-'Mechanical
_ Gas Tank
_ Gas Piping
_ Shutters
—Windows/Doors
_ Electric
_ Plumbing
_ Sprinklers
_ Generator
Roof Pitch
Total Sq. Ft of Construction:
rCost of ,on frr cti�� onuslaA c( JtJ o
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
amQil we�P/L Rn�n I �,UflZ:
Na'me:.v,:,
ddress: 400L1 4 /_6AIJ DD "'
Corripan
'ty:j7�} VJ ieK f P State>; •
ip Code: Fax:
hone No. !! 2 i 1 2 0 O 1
,Address:-
City: State:_
Zip Code: Fax:
Phone No
Mail:
ill Inn fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
SUPPLEMENTA111 1 MI LIEN IMAJ INE@RMAT1
.
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, 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."
Sit natT3`re nfOWne essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
OU T+
COUNTY OF
OF Lt_tne
The forgoing instrument was acknowledged before me
The for oing instru ent was acknowledge efore me
this day of irI 20B by
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification
.
Personally Known V OR Produced Identification
Type of Identification Produced
Type of Identification
Produced
{� Njoids(.i�a�tuWre
of Notary Public- State of Florida )
�O(�jC.(',(/ + r
A Y PUBLIC
No. Seal
T RL�SI�B/i )
+l /1�(
.g ry ST
Si nature of Nota Public -State of Flo i a)
(�l
GG041529
Commission No.(Seal)%)Expires
11/2/2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19