HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE, INFO MUST BE
Date:
Planning and Development Services
rOR APPLICATION TO BE ACCEPTED
Permit Number:
SCANNED
BY
St. Lucie County RECEIVED
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applicatio i APR 18 2,019
ST. Lucie County, Permitting
Commercial Residential
Property Tax ID #: 3"\ \ A — 5 \a . d ., d a a _ I 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:'
Cost of Construction: $ 1,, V/d
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height: 1
OWNER/LESSEE:
CONTRACTOR:
Name at/c ( ti d
Name: �c ✓IGAI �✓-7iI.Lc
1
Address:_ q J i �' - d I-f" �/ "
Company:?(21 Vtlq IS-e a ✓}-H tivr ! to c
� y f S"?, State: _
Zip ode: VS L- Fax:
Phone No.
Address: 3 S a ,C 44//
City: �� (, State: L
Zip Code: yf K1 Fax:
Phone No 72' rr - (OZ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
2 N-AO —LC-C
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.
DESIG
le I MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application;isyherebym`ade to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has cbfnmenced 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
Sig Lure �r�e/Contractor as Agent for Owner
Si r o/Caotra�ctose Holder
STATE OF FLO
STATE RID
COUNTY
COUNTY OF
OF 5%Y. Luce
The forggoing instrument was acknowledged before me
The foSSgoing instrument was acknowledge before me
q
this \4 day of a P f� 20� by
this�"b day of I by
Q f� i . 20A
�{
,10
Name of person making statement.
Name of Berson making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ProducedL—
Type of Identification
Produced �'i L
(Signature of Notary P blic-State of Florida )
1 '
M-16a EANNAMA�22029 l t
C mission No.T-4
(Signature of Notary Publi State of Florida) �--
RIEGNENSO
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Commission No. 6zG6a 16,29'
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Bonded Thm Notary J
IES:December
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