HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 15 / 1' % 0 Permit Nw
SCANNED
BY
s
at. Lucie County
Building Permit Ap
PlanningandDevelopment Services
Building and Code Regulation Division
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: ® L,Lr ft r r- � eel _
Address:
MAY 16 2019
ation
Permitting Department
St. Lucie County, FL
Residential --
Property Tax ID #: #*f323 -StOU — ES Lot No.
Site Plan Name: Block No.
Project Name: W
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:%2 0
Cost of Construction: $ e�
City:
_ Generato'r
Sq. Ft. of First Floor: _
Windows/Doors
' Roof -Pitch
Utilities: _Sewer _Septic Building Height:
Zip Code. Fax: OF
Phone No
E-Mail: R a
Fill in fee simple Title Holdery nex age ( if ift¢er�itt
from the Owner listed above)
Name:
Company:
Address:-.�-�_�:�--=-�----, •:: • i'.
City:'' :,n,,;,r s, • ' l t "i State:_
Zip Code: c " ,Fax:
-Mail
State State or County License
f value of construction is S2500 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.
' - ar 0
City State: '
Zips _ Phorrfe
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone
_Not Applicable
OWNER/ CONTRACTOR AFFIDAVIT: 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 fhe 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
45ignaturerofiown , see/Copt as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA�
%�_
STATE OF FLORIDA
COUNTY OF�QQ
COUNTY OF
The forgoing instrument was acknowledged efore me
The forgoing instrument was acknowledged before me
this _kk day of »� A,,Z
this _ day of 20_ by
���PoL ��ulwa •
Name of person making statement.
Name of person making statement.
Personally Known OR Produced IdentificatiotT__�
Personally Known OR Produced Identification
Type of I ent ton
Type of Identification
Produced
nOLWv—
Produced
(Signature of Notary P ic- State*?.)
(Signature of Notary Public- State of Florida )
Commission No. •"'?•"•••.""'••. AUDREYi6RO)ilipli
Commission No. (Seal)
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