HomeMy WebLinkAboutBUILDING PERMIT APPLICATION5
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Permit Number:
`3
rs, - SCANNED BY - RECEIVED
• _ St. Lucie Coon JUN 11 Zp�g
Building Permit Application
Planning and Development Services $T, Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, -Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 - Commercial -- Residential
PERMIT TYPE:
aa� t
PROPOSED IMPROVEMENT LOCATION: �
Address: ' $ 0 0 W
Property Tax ID #: 2212 ^ S00 !oO ato - d 00 - 5 Lot No. .b
Site Plan Name: Block No.
Project Name: r
DETAILED,, DESCRIPTION OF WORK:
t�nrtl a'- �iur9g}nt`rE�1,alp+ilE',.1,� i '
I CONSTRUCTION INFORMATION: 1. I
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:
Sq. Ft. of First Floor:
Cost of Construction: $ SOi 0b� '0`
Utilities: —Sewer _Septic
i
Windows/Doors
.Roof_. Pitch_ .
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name M ol,
3
Name:., .-- ...... ... .... .
Address: Al TigtluL; V4;p rz el,' iCompany:
r
'City:-,i- Qi d/CP State:
Zip Code: 34gy5 Fax
Phone No.-:772-370- 0311
5
Address:
City: State:_
7ZipCode:` Fax:
Phone No r
E-Mail: J3A+Ae70e-,(,2 Q 6101:-Cem
FIII in fee simple Titleliolderon 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.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 covenantsthat may restrict or prohibit such
structure. Please consult -with your Home Owners Association and reviewyour•dedd for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that.l.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 usesto 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 COMMENCE " '
I
ev. .,PSI
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:.
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
,'s State:
FEE SIMPLE TITLEHOLDER:
Name:
_Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City: -
Zip: Phone:
--
Zip: " Phone: '
Signature of Owner/ Lesse Hactor as Agent for Owner
Signature of Contractor/License Ho
STATE OF FLORIDA (� � I
STATE OF FLORID A% ' " � '' it •
COUNTY OF 1 _CI � 'e--
COUNTY OF
The forgoing instrument was acknowledged before me
� 201� by
The f oing instrume t was acknowledge�before'me
lam. 20'1_Ofl' by
this/
,this ;day of n��
l �J1 t i✓
p�,� Qd�a�y of.
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�`�f(,cNiLIKIKJ J
Name of person making statement.
Name of person making statement.
I /
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification
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Type of Ide tiff fo -
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Produced `l,�
Produced