HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLEINFO (MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: / f f J2� Permit Number: 1 0
Derr SCABY E® RECEIVED
St. Luciecounty JUN 2 0 2019
-�� — --I Building Permit Applicatio
ST. Lucie County, Permltling
Planning and Development Services _
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: —'-?n?,ff
PROPOSED IMPROVEMENT LOCATIO .
Address: 41-1
Property Tax ID #: Lot No. & 4- y
Site Plan Name: Block No.
Project Name: /rl/571i4 5rAIDP 6A
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTfON INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers ✓Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Utilities:. —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameT%��t �l/G�
Name:
Address: S/%O25i(,lir9 4W.
Company: -- - .• -
City: FT P)j5oeCE State:.eG •
Address:
City: State:_
Zip Code: Fax: 772-"& -7/7rf
Phone No. 77X - 4161- 06 7
Zip Code: Fax:
E-Mail: iytrY/r fC 1®fi9f/j, euci
Phone No FT
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN W I
FO MATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: -
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: Stater
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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."
(.I//- � /L)
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
1
COUNTY OF — • 1,._,yPN C
COUNTY OF
The for ding instr ment was acknowledge before me
The forgoing instrument was acknowledged before me
this3� day of 3 Ii_III E - , 20M by
this_ day of 20_ by
t � vreYte_o. m; JS
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Ide ifi ation
Type of Identification
Produced F 11) L
Produced
r
(Signature of
^= r='—'i
(Signature of Notary Public- State of Florida )
;oa,, KAREN S. NIELSEN
Commission
,� State of Florida@g�{{Y Public
Commission No. (Seal)
•` Commission # GG 207484
3,� ads My Commission Expires
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