HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —Cs(v? I (q Permit Number: nos-csqla
010141,41mr-u
BY
St. 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
PERMITTYPE:
Building Permit Application
Commercial Residential
Address: 4/70 '5� .2 /d //� , F-'�- /'1�4<- "�L Ti
Property Tax ID #: (D
Site Plan Name:
Project Name:
Additiona I 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:
Cost of Construction: $ _405zxv -7,-7oo
Itectro
rtment
cowity
Lot No.
Block No.
r-r,%
— Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
rNW, N E R TZ LMS 9 E.
113- 9 R ffi MMTE)
Name Ehtm.-ck ffso'� M-
Name:
Address:-4-10 lAv—
Company:
City: !F12r* State: -kL-
Zip Code: 3L(9 Fax:
Phone No.—r2--2x)1 -'�S-Lf(o
Address:
City: St a te:—
Zip Code: Fax:
Phone N' 0 1
E-Mail: (J,%o�(e Co,%
tj Cokc? t
Fill in fee simpleyltie Holder on next page if different
from the Owner listed above)
.
E-Mail
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.
DESIGNER/ENGINEER: Not Applicable
Name:
mMORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: —State:
Zip: _ Phone:
FEE -SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
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 Coun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conlylictwith any applicable Home Owners Association rules, bylaws or angcovenants 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 (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 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-"
—tractor as Agent for Owner
MrTeilr/; 156�9W,00
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The oing instrument was acknowlecleed before me
kly
The forgoing instrument was acknowledged before me
thic day of I Y IL� "a AA_ by
uwx'ri 0 �Q�
this — day of � 20_ by
Name of person making statement.
Name of person making statement.
_�4
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id
Type of Identification
Producecl!=�"
�of�Notary
Produced
(Sigtature Public- S%te of Florida ��-1
(Signature of Notary Public- State of Florida
Commission
ING MING
Commission No. (Seal)
LAS
A*%% yc MSION # GG 275M
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