HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l��►t!�
Date: ��1WIg Permit Number: 1 U
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address: 750 SE
BY
St. Lucie Countv
Building Permit Appl
Commercial
AUG 16 2019
Residential l/
Property Tax ID #: J31127 - 701 -60.56 - 000 — 9 Lot No.
Site Plan Name:
Project Name:
Additional work to be performed under this permit —check all that apply:
Block No.
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _ Plumbing —Sprinklers _ Generator —Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ T�
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE .;
;:
CONTRACTOR e'w '
_
Name T)aod avo Mlehelle
%.
Name:
Address: 150 56 Il ban
Company:
City: &,-- —we', e-
Zip Code: 83
Phone No. -11 P _ L Z32 jb'15
State: rV
Fax: ArA
Address:
City: 'State:_
Zip Code: Fax:
Phone No
E-Mail: tihL1lerrI,16du0l•C1)&'1
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 $ZS00 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
JVYYLCIVI CIVIHLa.V IVJIRVLItV1VaLIC1V WVV IIV I-VRIVINIIVIV ,.g
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
✓ Not Applicable
Name:
Name:
Address: 7 Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable I BONDING COMPANY:
Applicable
Name:
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 concurrencV 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 IIN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
P ON THE JOB SITE BEFORE THE FIRST INSPECTION. EF YOU INTEND TO OBTAIN FINANCING, CONSULT
YOURILENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Ucense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �O`('\ cka
COUNTY OF
The f rgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of K� 7ir 20A9 by
this_ day of . 20_ by
\ d F\x
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
Produced
(Signature of Nota rF blic- State of Florida)
(Signature of Notary Public- State of Florida )
Commissio Ili. REGINA E. INIGUE& all
Commission No. (Seal)
--rt7YCbNtYtI3310MH GG2950J§'
EXPIRES: January 24, 2023
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