HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJ 1 1
All APPLICABLE INFO MUST#E C4.:'r!ETED FOR APPLICATION TO BE ACCEPT' —
Dat . ' `c Permit Number.
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Building Permit Application �t Lucie County
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,
PERMITTYPE:.X) (ar
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Address:
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Property Tax ID #: c940S--703- X46-QW-q Lot No.1_
Site Plan Name: r Block No.
Project Name: -'ref' nawv P V
I DETAILED DESCRIPTION OF WORK:, 11 11
TION
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: Sq. Ft. of First Floor:_
Cost of Construction:$Utilities: _Sewer _Septic
Windows/Doors
_ Roof Pitch
Building Height:
OWNE /LESSEE:
CONTRACTOR:
Name [:�M-(Sooan
Name:
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Addre�s^s:-[
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Company:
City: r71(�+ P C'TC Q. State_:
3 Zip Code:4Q91 Fax: 1J (
Phone No.Tlotl 32L3-3-(66
Address:
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City: S 7C Stater
Zip Code:'S'JI46 Fax: QtA
Phone No 154-Cl UL4 -r�tlq 6
E-Mail:�)A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail W. 150 r% 5. Q r/) -S ( .
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.
S000LEMENTALCONSTRUCTION LIEN LAW iNFORMATiON
DESIGN �E C ilk#ER: r _NotApplirable
Name: t �( r l
MORTGAGE COMPANY: Not Applicable
Name:
Addr ss:o
Address:
City: n State: L
Zip: Phone 1— ', —cZ `1
City: State:
Zip: Phone:
_ FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: 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 Count es makes no representation that is granting a permit will authorize the permit holder to build thesubject structure
which is in conflict with any applicable Home Owners Association rules, bylaws orand 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
"WARNMIS TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE O_ F COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU D TO OBTAIN FINANCING, CONSULT
WITH OU DER O ATTORNEY BEFORE RECORDING Y U O OF COMMENCEMENT:'
Sigiffiture of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORj�gqA lSTATE OF FLORID I
COUNTYOF ��6 (lll()�Lic COUNTYOF .(ili(iCll
The forgoing instrqmentt was acknowledged before me The oing in ment s acknowledge before me
this day off'(s , 120j� by this day of 20 by
r-if1 PTAS (-N n i
Name of person making statement. Name of person making meet.
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Personally Known OR Produced IdentificationPersonally Known OR Produced Identification
Type of IdeQt wt1 a of Identification
Produced t— a Notary smmdFbd& duced
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Signature o otary Public- State of Florida ► ignature o N'o( ry PState oforid Fla )
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Commission No. (Seal) Commission No.l�(T�C (Seal)
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