HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: y�51 1� SCANNED Permit Number: VV1 �-t1
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
BY
St. Lucie County
Building Permit Application
Commercial
Residential
PERMITTYPE:`\ k�
Property Tax ID #:
Site Plan Name:
Project Name: _
Lot No.
Block No.
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._. •.. .'.
Alf M-Mifflo
• � 1
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: 0 ��5'-' Sq. Ft. of First Floor:_
Windows/Doors
Roof • ' Pitch•
s af-om4MC-tion Utilities: _Sewer _Septic Building Height:
OW NER/LESSEE:
e LL.v I A 1 R.
CONTRAGfOR:
Name:
ress: S&,APApnP-6LJ9�) �ItRt
Company:
i O State:T-L
i ode: `5�49 q / Fax:
o e No. 3( ( 442Z - 2nla I
Address:
City: State:_
Zip Code: Fax:
Phone No
il:hL4-n+er.0.nW
Fill in fee simple Title Holder on next page ( if different
fr% t 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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
Name:
BONDING COMPANY: _Not 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 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, 1 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
waft 6r of:Own' n) rr/ILbssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
5 e
STATE OF FLORIDA
COUNTY OF k,
COUNTY OF
The forgoing instrument was acknowledged before me
99
The forgoing instrument was acknowledged before me
thisa day of At (' iN , 20VII, by
this _ day of 20 by
Og o: _\ S wl�'-\1 h
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific tion
V ��^
Type of Identification "
Produced
Produced
(Signature of Note, ! IEGNENS
(Signature of Notary Public- State of Florida )
o_GOMFAIS5I0N#GG 072023
Commission No. y
Commission No. (Seal)
_
EXPIRESNIf��P�cUndenuriters
'••,Eos Y° BondedThn�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 21 // 19