HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �1 SCANNED Permit Number: (A Q
St'. bU BY RECENED
deCon"tV
• AU615 1010
- - Building Permit Application Department
Planning and Development Services Permitting
Building and Cade Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462.1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:G�,n. n
Address: j u s i'l f ct I u r i (A r w r r� ii.� A (.p
Property Tax ID #:3�22 — I og 3 -1 — oup — S Lot No3.� >'
Site Plan Name: Rkrk ni
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
ot-of;Construction:.$ � �Q� Utilities: ._Sewer _Septic
_ Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE: �, *
CONTRACTOR. .P 4
Name
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Name:
Addre�,s:: ` b
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Company i
City: 1°5 L State: L
Zip Code:'`,L%(P Fax:
Phone No. ?�_ QS( '� b ( 3'i
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Address: 71 5�1 ' MCA ( (L Cif' r- ).11a U
City: piS:t Pal M (2—x %/( Vti State: ,T(
Zip Code: a5q) -i°-- Fax:5lp (1 �13 -5%4
Phone No1O02q
E-Mail: Q-it)
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
--SipC-1C1
E-Mail,
State or County License
it vame of construction is yZ5uu or more, a RECORDED Notice of Commencement is required. �,�t��\,
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. t�\ v
SUPPLEMENtALCOIISTRUCIION LIEN IAVIf INFORMATION z
--D�ESIGNE ': NGI�J� E R:
Name: IA. 9
_ Not�y plicable
FLG' c!SC6 /Ce8
MORTGAGE COMPANY:
Name:
_Not Applicable
AddressSVIM 4%aOZZLL
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITWYOUR1.ENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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ESign ce o • w s� ..ConlractoL sJkg LOwner,
i f5jina1ifre ofiContractor/License Holder
STATE OFOFLORIDA, /� C A
COUNA_Rlm
STATE OF FLORID
COUNTY OF e"C_
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The fo ing instrume�}}}���vvvw acknowledge efore me
this Ydayof1�20[Iby
The fo Ding instrum t was acknowledged before me
this Ydayof 20& by
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Name of person making statement.
Name of person making statement.
Personally Known R Produced Identi cati P
Personally Known / O Produc n ' )cation
Type of Identifica.'
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Type of.ldentificati
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Produced
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(SigKatwd6e f o �(aj;P, ,rblic-S tg R(L NSON
,,,�.a>'�,, HARNIKA JOHNSON
Commission °%°: NA Public- 41AWof Florida
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Commission • • • C mission #1 ��
• : Comm] `[on $ FF 930970
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