HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEi eu FOR APPLICATION TO BE ACCEPTED
Date: ST1 \� SCANNED Permit Number:
BY En
ECEIVED St. Lucie County
Y 0 0 2819
- - -- Building Permit ApplicatiPlanning and Development Services C..ounty, Fermltting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 '
Phone,: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: :`�<ke\\ .10AC,
Address: 'c?/ 0
Property Tax ID #: `
Site Plan Name:
Project Name:
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
vlechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
'ONER/LESSEE:
GONTRAC«TOR:
Name i
Name: �i �•
Address:,. 13or?'--, �
Company; F—(Yrj
!! 1 ,-
r :
City: Stater
_i
Address;
-P!b,
Zip Codei i _�aX '
f
City. I
;' Stat
Phone No. f 959Y
Zip Code:•,•
Phone No
'Fax
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail�I()
State or County License C(2
le M��GYN
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:
Name:
_ Not Applicable.
Address:
City:
Zip: Phone
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
Zip
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
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 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 r ie : room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory u s to nother non-residential use
"WARNING TO OWNER: YOUR FAI E TO RECORD A NOTICE OF COMME EME MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEM OUR P ERTY. A NOTICE OF C MEN MENT MUST BE RECORDED AND
POSTED ON TH S BEFORE T IRST INSPECTION. IF YOU INT N O OBTAIN FINANCING, CONSULT
WITH YOU ER AN ATTORNE BEFORE RECORDING YOUR TI COMMENCEMENT."
Signature of Owner as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORI A
STATE OF FLORIDA r�
COUNTY
COUNTY OF 54,.yCt,,2
OF VCee-
The fo✓,rpp'oing instrum t was acknowledged before me
this v day 20 by
The forgoing instrument was acknowledged before me
�
of
this day f ! 20LL by
Q
, y/ /�
PGtPZ
t G e Z
Y t 1
Nam erson making statement.
Name of rson making statement.
Pers pally Known X_ OR Produced Identification
Personally Known -A OR Produced Identification
Type of Identification Produced
Type of Identification
Produced
_
(Sig ure Not lic- State of Florida )
Sin ure of Ota u li 5 a Florida-)
( g to Qf _ .,� ,
JOSETgqPP,ttAA
Co mis on No. ¢F'' Public. St aAorida
.. ., .`liw•r•ni: ••., JOSETAPIA
Co mi55i�o. Notary Public {fiflplbl Florida
J,3• Commission M GG 215487
A •'�'liaif}°°� My Comm. Expires May 8, 2022
Commission R GG 215487
Bonded through National Notary Assn.
V My Comm. Expires May 8, 2022
xn. !'
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Rev 2/7/19