HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4'1 y �I. SCANNEDermit Number:
BY
Building Permit Applicati n AUG 14 'Oi9 Planning and Development Services
Building and Code Regulation Division ST• Lucie County erm
2300 Virginia Avenue, Fort Pierce FL 34982 11 ,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address:
Property Tax ID #:
Lot No.
Site Plan Name: q I Block No.
Project Name: r. )C� �� Ce VI (1 A'e'
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Additional work to be performed under this permit -check all that apply:
_Mechanical Gas Tank _Gas Piping
jZ-6 `Plumbing _Sprinklers
_Shutters _Windows/Doors
_ Generator _ Roof " - Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ dj/ 60 •-P5000 Utilities: -Sewer _ eptic Building Height: z ACI_19 '
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Name m G
Name:
Address: 5 Yo �/ 'G�r a✓ r
Company:.."
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City: }—or� /v i✓LC State:,�li
Zip Code: -3 z! 7'lS Z Fax:
Phone No. g6 U ('-lJU
Address:
City: ` °:e:1 sr. :?, '` State:_
Zi Code: Farr ; r
hone No
E-Mail:occ2c, i71t4(p steal, -0
_
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Mosew �
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.
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
— Not Applicable
Address:
Address:
City:
Zip:- - --Phone _
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not 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 }O;B SITE BkFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YnI ID IrUnIMInD AIUATTnRNFY RFFORF RFcORo1NG YOUR NOTICE OF COMMENCEMENT." '
Ignature of Own r/ Le see/Contract Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6 uc��
COUNTY OF
The forgoing instrument was acknowledge before me
A
The forgoing instrument was acknowledged before me-
this� day of Q A , 20 by
this_ day of 20_ by
'\ \nd ,nw S w.a3 \Q y
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 q' L 'p, V
Produced
(Signature of Notary Pu ic- Stat OE
(Signature of Notary Public- State of Florida )
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Commission No. "�'(�r18,�9
Commission No. (Seal)
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