HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 9
Permit Nur—
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SCANNED
RBCEIVED
BY
St. Lucie County
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2919
Building Permit Applicatiorrer,,n
Planning and Development Services
St. Lu a epart ent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
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PERMIT TYPE:
Address:
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Property Tax ID #: ffo? 7 -
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Lot No./ 5'
Site Plan Name:
Block No.
Project Name:
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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 ofrConsicpetion- �-' C30d, Utilities: _Sewer _Septic
Building Height:
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Narneit
Al
Address
6961. Com AW
City: — V
State: _ Addre's1s:: l
Zip Code: C Fax: Ill
City: �A�4�0 M_17i_OS1it�
— State
Phone No.
Zip Code:
E-Mail:
PhoneNo3�h"
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Fill in fee simple Title Holder on next page (if different E-Mai{n h64gU
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from the Owner listed above)
State or County LicenseJ i�(f • /1J .
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.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: jj _ Not Applicable
Name: IIJ�
Name: , it
Q
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: 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. 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 IMPROYEMENTS 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."
%n—ature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA n-__
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STATE OF FLORIDA %�
COUNTY OF (l-
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COUNTY OF 6�14 / oad ..
The fp( ing insV67n e�nt was acknowledgebefore me
The for oing ins u ent was acknowledge efore me
this day o 20 by
this day o 20 ��by
(iaking
Name of person m// ing statement.
Name of person statement.
Personally Known OR Produced Identification
Pe o P.noV4V,,., �tWcPF0d@Red entification
Type o 'f.
Ty q'fifiFqglMs Donza
• CMG 082440
PrOdu d odic State of Florida
Pr '3}f� My Commisson
Frances Donza
'fcf ' �` fOS /yam.
c My Cg ,ission GG 092440
E*Ims071271202I
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(Signature of Notary Public- State of Florida) -
(Signature of Notary Public- SVate of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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