HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1!105 ~oLTJ
Building Permit
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
PERMITTYPE
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
RECEIVED
MAY 0 8 1019
ApPRQX*Qartment
St. Lucie Copnty
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing 1 Sprinklers
Total Sq. Ft of Construction,
Sh utters
Generator
Sq. Ft. of First Floor:
Residential
SCANNED
BY
St. Lucie County
z
Lot No.
Block No.
indows/Doors
_ Roof 5a Pitch
Cost of Construction: $ Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRALTO
Name Q i�iV
Name: �i
Addre _�[/S $
Company: T007.0 (���
City: v State: _
Zip Code: Fax:
Phone No.
Addre
City: �/ ZState
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mai ti5/ f r7rX;
State or Co my 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.
FORMA ION:
SUPPLEMENTAL GONSTR I I I ' LIEN LAWIN
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: pplkcable
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 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 NOTIC OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE EFORE THE FIRST INSPEC YOU ND T OBTAIN FINANCING, CONSULT
W LE ATTORNEY BEFORE F OUR NOTIC OF OMMENCEMENT."
Sign re of Own / essee/ ontra or as Agent for Owner
Signature of ont cto ice - Holder -
S ATE OF FIL I A
STATE OF .LO IDA
COUNTY
COUNTY OF 5�•
OF 64r. L pC\C
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �, day of TNM 120A by
this T day of fn4y 20A by
+-S t Ynw, ¢ i
Name of person making statement.
Name of person makin statement.
Personally Known OR Pr9pced Identification
Personally Known OR Produced Identification
Type of Identification Produced 1.
Type of Identification
'fit. L
Produced 11
(Signature of Notary blic-State of Florida )
Commission No.d
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Commission No. Ip '
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REVIEWS FRON ZONING SUPERVISOR
PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19