HomeMy WebLinkAboutBUILDING PERMIT APPLICATION� r- .
All APPLICABLE INFO' MUST BE COP'_-_,TED FOR APPLICATION TO BE ACCEPTE- Date: Permit Number: Rn. usga-'
BY
5t. LucieCoanfly RECENED
Building Permit Application jUL 26 1014
Planning and Development Services Permitting Do outment
Building and Code Regulation Division St. Lucie C°ntv
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: -;�b S i✓ A /6-iW 2
Property Tax ID #: -scVD 0,— b Lot No.
Site Plan Name: pS Block No. A6
Project Name: M rA,, JA
DETAILED 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:
Cost of Construction:$ ��J,�Qd
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam 70—dcl 1VASWX4)Name:
Address:I s S
Company:
City: fiZ qcrc-,--;, State:
Zip Code: & Fax:
Phone No. dO 9—)7
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 142asaFat.t.i 4'-)Sh hw fro/yl
'Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION`.
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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Wit\ uc z
COUNTY OF
The forgoing instruplent was acknowledged before me
The forgoing instrument was acknowledged before me
thi�o day of by
�7
this_ day of 20_ by
Name of person makmg statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
&-I�
Produced
a ure of Notary Public -State of Florida
(Signature of Notary Public- State of Florida )
Commission No. ytW!I G
GRAM-
Commission No. (Seal)
LASIiPLINAI
"'� ; MY COMMISSION # GG 275060
REVIEWS
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EXPIRES:
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COLIN
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REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19