HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d -I
Date: G () SCANNED Permit Number: � `�� d � q 1 1
- t, BY
i St. LudeCounty L
CEIVED
Building Permit Applic10 2o16
Planning and Development Services
Building and Code Regulation Division unt rerImItIng
2300 Virginia Avenue, Fort Pierce FL 34982 -- -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial \ Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATIONt`
Address: e16O
Property Tax ID #:
Site Plan Name: _
Project Name:
Lot No. it
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters endows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 3ti
1 0 0 Sq. Ft. of First Flo —
Cost of Construction: $ lb, 1000 • r Utilities: _Sewer _Septic Building Height:
01NNERAESSEE:
:C.0 NTRAC70R.
Name i lr O Q
Name:
l
Address: d
Qn+r ( Q (
Companyt,
City: p %iPrl%0 State:F1
Zip Code: 1 Fax:
Phone No.1 " 0% Z13
Address: 02"4
City:W i M a U YholStater
Zip Code:
Phone No $ %
Fax:
%2 j3�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail O ('r) Q k IP
f r - Cb
State or County License
MMO
it value of construction is 5Z500 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.
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SUP lE1VlEN1AECflNS7RUCFIQNL1EN lAW 11FQRMA
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con list 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 3&A �y�t�
STATE OF FLORIDA
COUNTYOF Sk• LJr't�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of i O v`'k 26A� by
this \d day of Ju »s 20kA by
Aab•,r C00\1k.
�-d 6',,n rob\e,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of IdentiRS tion
Produced 1 L
Produced ` C. to L•
(Signature of Nota ublic- State of Florida)
j gnature of Np
FJ GIVENS iJ
Commission No. G<v6 2- ,. RIE GIVENS
ea �,,NNA Op2o
w••••"• DEANNAMARIE
"'; eG0'l3 l
OC -mission No.; d'�OYt'�MtAlSslo t {,
_
•*Li 'p'"'"k,',s• NIY GDMSADrG6.20
- . - ° EX �ftES: Decelny:er 2020 I
No�ry Merudlers i
PublieU
11. '•+e IRES.,. Undo�Iers%eo«Coe`
BondedThru
REVIEWS
FRONT
i0i7P
ISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev.2/i/19