HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 51 1 l� SCANNED Permit Number: 0(3'&d
u BY
St. Lucie County D FrGT%/Gr)
Building Permit Appl
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
PERMIT TYPE:
a�3y-s3�- Dool- o
Site Plan Name:
Additional work to be performed under this permit— check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
TotaLSq Ftof-Construction,> ! -0
_� :jam ._:...
Cost.of Construction: $�
e.�__.,:r
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
MAY Q 12019
ST; 1,00 County, Pormlttl
Residential
Lot No.
Block No.
Windows/Doors
Roof Pitch'
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:'
ft rSo
Name:
ess: ���D eibee l
Company:
VNbeR�7�1A�
r+, f �V-CE'_ State: EL
Address:
Code: 3 i%q g Fax:
City: State:_
Phone No. 78%`_ gS 9S7S
Zip Code: Fax:
Phone No
1Mail- COPY)
FiII•in fee simple Title Holder on next page (if different
E-Mail
State or County;License
from the Owner listed above)
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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City: , " ` 7N State:
City:
State:
Zip: Phone f
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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
commencing work ox-Feeording your Notice of Commencement.
f Signature o wntij essee/ o ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY F Sk-1.oc�C
COUNTYOF
The forgoi g instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this \ day of MaY 20 !A by
this _day of 20_ by
t�0_We.�a F4Cq�bwCSC Y1 '
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced F L J�
Produced
f6FAthRIEN4-
(Signature of Notary fi ;Ye of I SIONacco22023 I
(Signature of Notary Public -State of Florida )
e_ EXPIRES: December 16, 2020
Commission' No-. 'q Banded T"4ryPuhLcOndenvdte
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. y/Zb/lb ' N