HomeMy WebLinkAboutBUILDING PERMIT APPPLICATIONAll APPLICABLE INFO MUST BE 00114im�c-TED FOR APPLICATION TO BE ACCEPTElj
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Date: SCANNED Permit Number: cxoa 'J
BY
St. Lucie CountY
Building Permit Application wall""
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Itiang uepallme"
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential XTSt. Lucie ouv*/
PERMITTYPE:
Address: :.'::> '-I-
Property Tax ID #:
Site Plan Name:
Project Name:
[CONSYRU'driON INFORMI&10'k:'�
Additional work to be performed under this permit -check all that apply:
-_Mechanical — Gas Tank —Gas Piping —Shutters
— Electric — Plumbing —Sprinklers —Generator
Total Sq. Ft of Construction: — ? 0� () Sq. Ft. of First Floor. _
Cost of Construction:$ 8160(0 Utilities: —Sewer Septic
Lot No.
Block No.
—Windows/Doors
Roof Pitch
Building Height: 1 9- d
�OWNER/�MEE:-:
CONTRACrOR:
Name
Y
vo�
Name:
Company:
AdclresstS�:(04 SYner- 190L�k 1)�—
City:F4 Pyeti--to, State:
Address:
Zip Code:,-39 C, ga Fax.
City: State:—
PhoneNo. )')Q 4(0) SQ71
Zip Code: Fax:
E-Mail: m4�)Aulgre-
Phone No
E-Mail
Fill in fee simple Title Holder on next page (If different
—
State or County License
from the Owner listed above)
N value of construction is SZ500 or more, a RECORDED Notice of Commencement Is required.
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement Is required.
NSTRUtn
MAT110-
DESIGNER/ !NEER:
Not Applicable
MORTGAGE COMPANY:
—Lflot Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone -
FEE SIMPLE TITLEHOLDER:
-L_,,Kot Applicable
BONDING COMPANY:
_LAot Applicable
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.LucleCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is in conlict 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 concurrencV review: room additions,
accessary structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNEIV 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 IINMD TO OBTAN RNANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR LwrKz OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Ucense Holder
STATE OF FLORIDt','
STATE OF FLORIDA
COUNTY - - �,U A
COUNTY OF
The ftrgoing instrument was acknowledwel before me
The forgoing instrument was acknowledged before me
thi<21. day of 2A 2 _ by
U
this — day of � 20L._ by
Name of person making statement.
Name of person making statement.
Personally Known _ OR Produced Identification
Personally Known _OR Produced Identification
Type of Ideptification
Type of Identification
ProducedVI , I WAFI�
Produced
(Signature of Notary Public- Stft of Floffda
(Signature of Notary Public- State of Florida
Commission No. M GMM.P'WMING
Commission No. (Seal)
M Comm, SSION # GG 275M
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