HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll
FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division .
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address:
Property Tax ID #: l"
Site Plan Name:
Project Name:
Permit Number: t—lo 5105
57
RECEIVED
MAY 2 12019 SCANNED
Building Permit A licatiorl9_Departme BY
�� St. Lucie County `�`• LUCI COur
Commercial Residential
Lot
AckillitiAnal work to be performed under this permit —check all that apply:
_ chanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
otal Sq. Ft of Constru ion: 04ftlo W Sq. Ft. of First Floor: i
Cost of Construction: $ 5 1 Utilities: —Sewer (Septic Building Height:
OWN E ESSEE:
CONTRA R:
Name
Name:
Address:
Address /' V.
City: i� r r.� 0_ Sta
Zip C76'de� Fax: J��lt
Phone No. 12 —
City: � t 1% Sa
Zip Code: Fax:
Phone No 3
E-Mail:
Fill in fee si le 4 IeW Ider o6 next page ( if different
from the Owner listed above)
E-Mail /
State or Count icen
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.
S4UPPLEMENTALCONSTRUCTION LIEN LAW
IN
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DES GNE EN 11\11
Name: �f�'
_ NotApplicable licable
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MORTGA E'�DMPA N Applicable
Name:
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Zip: hone
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City: " tate
Zip: Phone:to
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMP NY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone: I
Zip: Ph ne:
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 ENCEMENT MUST BE
DED
WITH,POST%OURNL NDEOOR AN ATTORNEY BEFORE RECOR NTS TO YOUR PROPERTYP� ITE BEFORE THE FIRSI . IN ECNGIYOUR N3N. IF TMM F COMOMENCEMENTIN NCINGRCONSULT
Si wner/ Lessee/Contractor as Agent for
STATE O
COUN'n FFLORIDAk % �&cj•
COUNTY OF
Signature of Contractor/License Holder
IDA
COUNTSTATE OYOFOR� /Q�r_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _day o�f� � (j,U �20_ by
� 1 � j ' _ `
this _ day of� 20_ by
,
Name of person making s atement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Type of Identification
Produced /,i
Produced �(�-��%���%
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(Signature of Notary Public -!Rate of Florida
(Signature of Notary Publict State of Florida)
Commis n�,N & Fi I Fn1 VAUGH3kal
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State of Florida-No4ary Public
5 •e Commission K GG 270079
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Commission N �a p+ko•*, 4 uhlic
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'e• •c Commission N GG 270079
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DATE
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DATE
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