HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��p(
Date: L/ 6� /9 Permit Number: Rog -os (`1
SCAgNNED RECEIVED
s St. Lucie County APR 2 4 2019
— Building Permit Application Pefmig
St L'ude Countyent
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓
PERMIT TYPE:
Address:
Property Tax ID #: K 1/0 6 d 3 ^ 00 OC96 Lot Na.JC 7 6 re
Site Plan Name: Block No. 6_
Project Name: Slo7
DETAILED OESGRIP/T�II
�aCa li A Ca
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: �; O Sq. Ft. of First Floor: G
Cost of Construction: $ 90f IO � Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
oO
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gc -eq or c o T% ' l P^
Name:
Address: 7 G onw •
Company:
_
City: State:
Zi Code: ��, pz
p O Fax:
Phone No. 77.2 sa 8 Sa 71?'
F
• , - '
City: `,? __, : State:
;Zip -Code: =''K^ '.Fax:
Phone No:,
E-Mail: 0J,41J C(/Soa,44
_AZ
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 52500 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.
/ Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: 1 Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
City:_
Zip:
Not
Applicable
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 holderto 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 restriction"s'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 LFNOER OR'AN-ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.".
x
4
Signature of O er/ see Contractor as Agent for Owner
Signature.of Contractor/License. Holder,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY �,p ]
COUNTY OF
OF � )fi-�p�
The forgoing instrument was acknowledged before me
The forgoing instru nt wasacknowledg�before me
this_ day of 20_ by
this day of` by
I12e0)
J ' Onnf1 9 r 41 u(
Name of person making statement.
Name of person mak g atement.
�.-
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
'
Pro ced L_
Ah
(Signature of Notary Public -State of Florida )
Commission No: (Seal)
Si na re of Notary Public State of Florida
Commission No. LAg MGRAM-RAMMING
-
::R••*::.`°; MYCOMM0ION000275=1
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Rev 2/7/19