HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED OF - Don
Date: Permit Number:
SCANNED
BY
RECEIVED
Building Permit Applicati6n AU5 0 610119
Planning and Development Services
Building and Code Regulation Division PermItUng Department
230011irgin�Avenue, Fort Pierce FL 34982 e County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Property Tax ID #:
Site Plan Name:
Project Name: ^
Lot No.
Block No.
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
Total Sq. Ft of Construction:."*
Cost of Construction: $ �-X* fl
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Pitch
CONTRACTOR
Name rfy')I�Y-u
Name:
dclre�s:
A ' - OL M,
Company:
City'Mw State: %t,
Zip Code- 3 Fax:
Phone No. X72, f 7 1 �14
Md
ity- 7�'; State:_
ZiRCode* Fax:
Phorie"No
E - M a i 1: In0a I pl-g- S It-ai 03" C?
Fill in fee simpC 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.
9
ft
tj
DESIG NER/ENGI NEER:
Name:
_NOtApplicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City.
zip Phone
State- 0
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 6 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, IMMEC-11ION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER'OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.�
�9(
Les
r L seelContraalbi� as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL04A
STATE OF FLORIDA
COUNTY
COUNTY OF
The forgoing instruNnt was acknowledg before me
The forgoing instrument was acknowledged before me
th is day of li 1 140 by
�" A 1,55 %
this day of. 20 by
Name'of p6rson %aking statement.
Name of person making statem ent.
I
Personally Known _ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
WgnAture of Notary Publik)State of FloridaM
(Signature of Notary Public- State of Florida
Commission No. L�ShAqSbINPRAMAAHMING
Commission No. (Sea[)
MY GOV'!!�. SION # GG 275060
EXPIRES: Deoembhn )n?g
Q3ndQedThftWNa
PublicUnderwrilm
REVIEWS
FkW6��
PLANS
VEGETATION
SEATURTLE,..,
�AIANGROV
COUNTER
REVIEW
REVIEW'
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19