HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE IIN,FpO� MUST BE COM
Date: ) 7
FOR APPLICATION TO BE ACCEPTED
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 Number:
SCANNED
BY
St. Lucie County
0r' 6 �9
MAY 2 9 2019
W
Building Permit Applica ii I mitting Department
St. Lucie County, FL
Commercial Residential v/
PERMITTYPE: 4? (Z
PROPOSED IMPROVEMENT LO�CALTI ✓ ,
Address: % A \3 , / l
Property Tax ID #: I c� / n Lo D'7 � D 0 0 )— C) (S) y Lot No.
Site Plan Name: c� I Block No.
q
Project Name: �a L pI.LClM 1/ 1J� S / 7t-ek -
Additional work to be performed under this permit - check all that apply:
/echanical _Gas Tank _Gas Piping _Shutters
Electric' _Plumbiing _Sprinklers _Generator
Total Sq. Ft of Construction: qfZ� s
Cost of Construction: $ 'S
v
Sq. Ft. of First Floor:
Windows/Doors
Roof IPitch'
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
_
Address FL
Company:
_
City: vp4Q (CQt® State:JL
Zip Code: g Fax:
Phone No. -1-iz Zen
Address. -I,
City: '41 -i
Zip Fax:;
Phone No '
E-Mail:
\ a a WN\ , b
Fill in fee simple Atle 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 App
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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."
S�gnata _L Ratner/ Lessee/Contract as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL
STATE OF FLORIDA
COUNTY O
COUNTY OF
The forgoing instrument was nowledged efore me
The forgoing instrument was acknowledged before me
this day of 20 � by
this _ day of , 20_ by
Name of person making sta ment.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IcteTitif' tion /nJ
Type of Identification
�
Produced it
Produced
(Signature of N tary Public- State of Florida j U
(Signature of Notary Public- State of Florida )
Commission N ::ffi'''t"`?. AUDREYB.HU Y
Commission No. (Seal)
;. MISSION GG 300817
..... p EXPIRES: March 8, 2023
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Rev. Z///19