HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�`�'
Date: `'
SCANNFFO Permit Number:
BY
St. Lucie County. - RECEIVED
-- _-- Building Permit Applicatio rl JUL 2 4 2919
Planning and Development Services
- Building and Code Regulation. Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 - -- - - - - - -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Addr" ess _
/L '� s 41 Yl e %
V/�
/' /�/�
Property Tax:ID:#:�,Igso ? ; 5o I - O�`i" A l h ' 9 Lot No.
Site Plan Name: Block No.
Project Name:
DETrAILED DESCRIPTION OF WORK:
CONSTRUCTION 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'Co`netrucfion: $ ) bocll- Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR;
Name:
Address: iJ�I'Q1
-2S V
-,Company:
City: J2hSL'_t t'e_Ct_ " Stat
Address:
City: State:_
Zip Code: 9LME�7 Fax:
Phone No. (�� �s=52 34 —a-d�
Zip -Cade:.:-.. Fax:
j1)
E-Mail: 1 tt ,±In I CA P 0-• knl (1j ��i
Phone No
ilk Ie:simp(e 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.
j.
SUPPLEMENTAL CON- TRUCTION LI -N INFO
MATIO
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City:- State: -
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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."
J L—&
tS�Ign re of'cq/ One Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
L,
STATE OF FLORIDA
COUNTY OF
COUNTY OF
or
The ing instrmept was acknowledge before me
The forgoing instrument was acknowledged before me
this 0 day of 20n by
this day of 20_ by
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification r
Personally Known OR Produced Identification
Type of Identifca '
Type of Identification
Produced
In
Produced
(Signature of Nota ublic-
..„ K REN S. NIELSE
5
nature of Notary Public- State of Florida )
„
``�OPPPYW 'i
Commission No. ,� V s to ppf Florida•Natsry R
._ @$fiiinission N GG 207
bl a
0�o
mission No. (Seal),
M commission Expir)5
y
June 12, 2022
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Fev277/719