HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: I ri o- I! 1 gSrANNED Permit Number: orI S)
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St. LucieftrAy
RECENED
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Building Permit Application JUL i
permltung Department
Planning and Development Services St rude County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 \
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential r
PERMITTYPE: Try prllov-
pR�POSED.IIVIRROVENIENTL�CATION- :•. ,°�'. �.
Address: CXVLJ- ►Z
Property Tax ID #: 014
Site Plan Name:
Project Name:
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Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
Lot No. ,7 -3
Block No. 3
Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $,k 2,5,00.00 Utilities: —Sewer _Septic
Building Height:
OWNER/LESEEi
CONTRACTOR
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Name IflerizkzName:
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Address:
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Company: Ctw CaderO
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City: e✓" State:—
Address: q
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City: ��� iPlCC
State:
Zip Code: 3�)OK'4 Fax: /
PhoneNo.
Zip Code: ,? TY/ Fax:
Phone No �' d?
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail
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G. CO
State or County License
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S L 11 i° 3
from the Owner listed above)
If value of construction is $Z500 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 LAW INFORMATION:
DESIGN ER/ENGINEER:C
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
x Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
,XNot 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."
r r U6 "ram
Si Owner/ Lessee/Contractor Agent for Owner
'nature Contractor 'eense Holder
ature of as
of
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S}. II iX i4Z--
COUNTY OF S-r. L LAjC:-Q
Thelf�fo.rggoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
--.:TUNS.A
thisLfu day of �L.L� ' 201CI by
this day of 20A by
'JJpfen Mori &vc_
50ired IM)ct�rR_
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
(Signature of Notary P blic-S15ranature
of Nota P Ij r5 a cgdtlrl bit stwe of Florida
00�, Nomry Public state 0r F10fld
Angle Tatiana Pardomo
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Commission No I e Tatlana Perdomo
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Cc mission No. Mycomr�.024960
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q MY Commission
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