HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
FOR APPLICATION TO BE
Date:
Permit Number: jq C)Q . i DS9
SCANNED
BY
Buildingt'Iie�milg'RWplication ,�o
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
w'go ��o
ryP064.� P'f
Residential_
PERMIT TYPE:
i?ROP,OSED If�IPk6V'tME(�7`�OCATION 5 ua ;,
.._�
Address: ( r7Fn A —
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: 50A&&j.0 anuc'tjL"Ajdc-rfC /IuC1� l
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ %Zn�!3
_ Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:_
Utilities: _Sewer _Septic
-Windows/Doors
Roof
Building Height:
Pitch
O NNER/LESSEE # - fti
CONTRACTOR
Name e.
Name:_
Company: VLQ� EL—gLj)�(c�
Address: S itf 3 ' I
City: :tAx"s Stat
Zip Code: , `� - I Fax:
Phone No. ZCa — --45
Address:146 QL7 �rl�SNla.i
�da �,r
City:'PS i,
Zip Code: 349S-r3 Fax:
Phone No Z Ll —L192-9
State: fC,
E-Mai1 m.-. e %! �0 .
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
' ,H
State or County License C o
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.
SUPPLEMENTAL"`CONSTRUCTIONL(EN
LdUU INF'ORMATIOIU
5 ,°
i.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip:
Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
_Not 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 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
UK AN AI IUKNET t5trUKE MLUKUING TUUK NONCE
as Aaent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ZAl _u COUNTY OF
The forgoing instrument was acknowledged before me
this lk day of Co e� — 20—M by
Name of person making statement.
Personally Known OR Produced Identificat1w
Type of Identification
Produced
(SliguAurTork&fary Public- St of Florida)
Commission No.
WC
OMMISSION # GG 275060
The forgoing instrument was acknowledged before me
this _L� day of 201a by
Name of person making statement.
Personally Known _
Type of Identification
(Signature of
Commission
OR Produced Identification°
LISHANNA
EXPIRES. Decembe120, 2022
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