HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BEI�OMPLET6 a 1 )R APPLICATION TO BE ACCEPTED
1
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (712) 462-1553 Fax: (772) 462-1578
PERMITTYPE: SFZ)
Address:
Property Tax ID#:-15U1 '
Site Plan Name:
Project Name:
DESCRIPTION OF WORK:
I CO..NSTRUCTION'INFORMATION:, .
Building Permit Application
RECEIVED
JUN 21 1019
Permitting pepmrtmq ,t
St. Lucie County
Residential >�_
Lot No. .IS
Block No.
IM—
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping XShutters & Windows/Doors
Flectric Plumbing _Sprinklers _Generator TRoof Pitch
Total Sq. Ft of Construction: Z Sq. Ft. of First Floor: 200
I
Cost of Construction:$ /QIII fYl0 Utilities: _Sewer LSeptic Building Height:.
OWNER/LESSEE: -
CONTRACTOR: -
Name
Name:
Address:33c6 •Se,161--Company:-IsJJ`-\-L.(_C.
r —^
Address:3300 C Q_&N6poc-)Ae,101
City: State: _
Zip Code: '17 Q C94' � oZc6 a • 3 Wo
Phone No. i`la-u53-1-AkLk .
City: MC,.
Zip Code:ga-
Phone No 77a-I4,S3- 'Lf I �f 3
E-Mail: .Do au7@cr�cctR rrr
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mai JbC 'r-O
State or County License C C k
IT value or construction is >ebuu or more, a rctt vnueu notice or commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement 19 required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
-�
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: C�- Not Applicable
BONDING COMPANY: }_C Not 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.
is inOconilict with anyapplicablelHome OwnerstAssociationi rules authorize
bylaws or and covenants that maly restrictborprohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
o 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 jobsite
before the first inspection. If you intend to obtain financing, consult with (ender or an attorney before
commenciri Work o recording our Notice of Commencemen
Signature fON r/Lessee/Contractor as AgentforOwner
Signature f ontract License Holder
STATE OF LORIDA
COUNTY OF Sic-(icr�Q
STATE OF FLORIDA
.
COUNTY OF MC'.Vard
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this4clay of_'S w.Q 20_by
t�hisl(' day0f �fi0 20/`I by
WIU�ufn�V fir.
Name of person making statement.
Name of person makin— g�rrent.
Personally Known X 0
ersonally Known OR Produced Identification
Type of Identification ., :> •., KAREN D'ON0 t8�-
e-1,
a of Identification
Iroduced
Produced y MYCOMMISSION#GG737558
EXPIRES:Au9=5.2022
0ondadThnl NaterY peMicuderxrileB
Signat a of Notary Public- State f F rida
(Signa u e of Notary Pub "
Commission No. Seal
(Seal)
`.fir .e BAYLIE EIKMEIER
;o :State ppYY plgqritla-Notary Publi
Commission No. -� fbn p GG 235138
.__ ComMi
?:? �?= MY Commission Expires
��� July 04. 2022,
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