HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ SCANNED RECENED
BY JUL 0 9 7s�s
• St. LucieCounty
— permitting partment
BuildingPermit Application St.Lurlp6evnY
- 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
PERMITTYPE:
PROPOSED I PROUEME'NT LOCATION:
Address: 3 a
p
Property Tax ID #: 'L V O� —& Lot No.
Site Plan Name: l0 Block No.
Project Name:
DETAILED DESCRIPTIO OF WORK:
Q -
L-
S P�
GONSTRU I 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
o
Total Sq. Ft of Construction: 6n Sq. Ft. of First Floor:
Cost of Construction: $ 00 Utilities: —Sewer _Septic Building Height:
OWNERfI SSEE:
LOJ TRACTOR;
Name QYYI
Name: !yl
Address: 3
Company:
City: Gj�2 State:6�
Zip Code: d Fax:
PhoneN,o. 7 01
Address: Plrl X l4
City':;1✓b 17:�� - " - Stater
ZipCode: .'Q'ZO/3 Fax: '
Phone.No' '
E-Mail: i a rYe
S ri 0, 1 j,9A/)A 4n)
Fill in fee simple Title older on next age ( 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.
S PP IF L CEOIff.
DESIGNER/ENGINEER:
Name:.
ON 9 H W
_ Not Applicable
O A 0
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 coricurfency 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/C qtractor as Agent for Owner
Signature of Contractor/License Holder -
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF C lla
COUNTY OF
The orgoing instr ment was acknowledge before me
by
The forgoing instrument was acknowledged before me
day 20_ by
this, of
this_ of
\,�z — ^1'20
TyR N,ro��t uGY a=
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 Identification
Produced
Produced
' at re of Notary Public-S 4e of Florida)
(Signature of Notary Public -State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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