HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEI'' OR APPLICATION TO BE ACCEPTED
Date: `T\1`� Permit Number: �goN-gy33
Building Permit Application APR 17 ?p+g
Planning and Development Services MT, Gue1e
Building and Code Regulation Division Cnunry, Pnrm«t;ng
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential v
PERMIT TYPE: i d�e Qa f fl SCANNED
PROPOSED4 P,ROVEMEN,TiOCATIONt'
Address: (6
PropertyTax ID #:
Site Plan Name:
Project Name:_
—6cc) —
Additional work to be performed under this permit —check all that apply:
—Mechanical —Gas Tank —Gas Piping —Shutters
—Electric —Plumbing —Sprinklers —Generator
Total Sq. Ft of Construction: �c1 %U Sq. Ft. of First Floor:
Cost of Construction: $ S1J0 Utilities: Sewer Septic
Lot No._
Block No.
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSF}E; `'.?.CONTRACTOR:
V°
Name / v /D
Name:
Address: to ZOU=/U�/c� tkArliun
�r�
Company:
City: Ef - e[-fie
Zip Code: 3 YW 7 Fax:
Phone No. —
State:FC
— %
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 5C%1/1 -OheReWAAtTSC9,e2!./LL
Fill in 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.
SUPPl. N1ENT.ALCpI k_,-;
'91M L1Et LAV1 ,N�ORI IQTIO
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip:
Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE-HOLDER:
Name:
_ Not Applicable
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 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
x�
Signaturte o caner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 k , Lovr C COUNTY OF
The forgoing instrument was acknowledge before me
this=\ day of C`% by
Name of person making statement.
Personally Known
OR Produced Identification
Type of Identifi£at
n,.�. Produced �t
(Signature of NotaryWSW-
�MaR1E#rG NS2 '
ONIYCOMtdISSION# GG 02202.Commission
No,
EXPIRLSK11 Mber76,2020nded
ThMNotary Publle On'
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
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