HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO M, T BE CONirLcrED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY CA
D
St. Lucie County
3 0 2019
°- Building Permit Applicatlnty, Permitting
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: Q�
PROPOSED INPROVEMENT'LOCATION: -
Address.. ,
Property Tax ID#: 2 -M3-0I05-wo-S Lot NolB
Site Plan Name: IDnPu n 1�f' Block No.
Project Name:
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 Pitch
Total Sq. Ft of Construction:
Q
Sq. Ft. of First Floor:
C�JL0
Cost of Construction: $
07
L
Utilities: —Sewer _Septic
Building Height: _)
OWNER/LESSEE:
CONTRACTOR:
Name J
Name:
Fth
Address: TAIV SMUCompany:
i Y
City: State:
Zip Code: Fax:
Phone No.
r �
Address: w J
City: 1 rl LL State:
Zip Code: 9 Fax:
Phone No —l"lZ 332- V-450
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailY'IC'b)r-001/C+iJ&0QM/0TX
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 TITLE HOLDER: _ 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, 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.
-8r_Z�4 ��J g:�� .1 V-'
VC
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Signature of Contractor/License
Holder
Signature of VPner/ Lessee/font ctor as Agent for Owner
STACOUNE OF
STATE OF ORID��
TY OF IU�� l 1
COUNTY OF
i UrI
The ng instrum, t as ac no vied before me
this ayof_I11 / 20 by
The in instrumen eta
thisdayof J�
cn wled a fore me
20 by
v
allP
Name of -person malling stat ent. I
Name of person making atement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig a ary Pu lic-Sta,q(;Fjp tda) KATHERINE HAVENS
?' \^ MY COMMISSION #GG165030
Commission No ';�,A I�ArSe�>•PIRES:OEC O4, 2021
Bonded Nrcugh 1st State Insuranc
(S!gVkatW of otary Public-Sta
o..*Yc
KATHERINE HAVENS
issionNCommi(ffd MISSION#GG165030
91EXPIRES: DEC 04, 2021
Bonded throu h is
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