HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` - 1C) I 9 Permit Number. Mq - cs S
SCANNED
r BY ��•>5 dad
o St. Lucie County Wye o \10
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99:
Building Permit Application 6`oti,ti�ad
Planning and Development Services y
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE: VR- VA
Address: S D I -Z) /�'KIA r)")y-t n) y .'i
Property Tax ID #: �2 -60q -07-153- O - O Lot No. _
Site Plan Name: T7orcs Block No. 56
Project Name: T-76 % e S
DETAILED DESCRIPTION OF WORK:
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 Roof J Z. Pitch
Total Sq. Ft of Construction: :1 0 Sq. Ft. of First Floor: 14770
Cost of Construction: $ Q Utilities: —Sewer —Septic Building Height: �S
OWNER/LESSEE:
CONTRACTOR:
Name
rCs
Name: rhoi
Address:
Company: VS
City: r State. FT
Zip Code: L Fax:
Phone No. U S
Address:
City: (:HPIM C SL State:
Zip Code:_„3� Z^ Fax:_7��
Phone No
E-Mail:
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.
SUPPLEMENTAL CONSTRUCT( NLIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: of 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 bylaws
rules, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
cornmencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF
COUNTY OF (fir in
COUNTY OFORI �
The fo oing instru ent wag acknowledged before me
this day of ] I 20 by
The fo ing instrul t w s acknowledge efore me
this day of 20by
On r
)cnarn► ollf- h
Name of person makind statement.
Name of person making statement.
Personally Known —\L/' OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ature of otary Public- Sta e
KATHERINE HAVENS
5030 o"pV P`Bc
o mission N /1/'DI :/ �o Y MMISSION #GG16503
lC 1 '2 e`E.f�IRES: DEC 04. 2021
uranoe �^..� Bonded through tsl State lnsuran
e
(Signs e o otarylic- State of
�
Commission Not�Q
„ KATHERINE HAVEN
z°!' o�o MY COMMISSION
a)
H q1U EXPIRES: DEC 04, 20
Ofptl Bonded through lst State In
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