HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO
Date: Lf
FOR APPLICATION TO BE ACCEPTED
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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:
I.
Permit Number:
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APq I eF�'Fa
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Building Permit Applicatiolft.4 � NNE®
�nry
St. -Lucie CountY
Commercial Resid . ,iw—
Property Tax ID #: 3G�g���0 0 )� �l ` `� (��Q
Site Plan Name:
Project Name:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total�q;- t-&-`Coiist ii o_n: 21 Sr
—Shutters
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Utilities: _Sewer _Septic Building Height:
OWNER LESSEE:
CONTRACTOR
ame R-c k-L�\a .r rMa-c-f;; J'(�
Name:
Address:_ i
Company:
City: r ` State:.
Zip Code:, 2, Fax:
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hone No. % % Z'^ X, Z 6{ —q
Address:
City: ' s. ; s State:_
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Zip tode: = Fax:
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Mail: :C �`.{ �t i�n� nit. �'4c
II in fee simple Title Holder on next page (if different
rom 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.
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,.) 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 LENDEWOR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF, COMMENCEMENT."
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Rev 2/7/19
SUPPLEMENTALCUNSTRUCTION LIE LAW INFORMATION:
DESIGNER/ENGINEER: i � _Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Les a/Contracto'r as Agent for ner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY (�(' �,A�
COUNTY OF
OF ��1
The forgoing instrument was acknowledged before me
_
The forgoing instrum nt was acknowledged before me
this _day of 20_ by
thisda�yo�f�/_�/��,��,,20� by
"cw'a�•1i1,1 � 2
`1", {' 1�,`/ 1 [i{f✓�
Name of person making statement.
Name of person making statement.
Personally Known FOR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identifcation
Produced �2`�/i
�� /
(Signature of Nota