HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONy11
All APPLICABLE INFO MUST BE COM" FLETED FOR APPLICATION TO BE ACCEPTa� 1 Q
Date: L ` . PWhilzin Permit Number: 1' 1
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Lzels St Ludo COUPit/ S E P 12 2019
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Building Permit Applicati [{T. Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $�_-� �
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
%LESSEE: s s
CONTRACTOR:
,OWNE*
fVam
Name.,
it I16—. jn) ) AVLP_ _
Address: G
Company:
City: "P(C92_ State:Fl
Address:
City: State:_
�ZipCode,JQ:�a Fax:
Phone No�)'� C
Zip Code: Fax:
Phone No _ ^
Fill in fee simple Title Holder on next page ( if different -
tt
`E4ail"
State or County License
from the Owner listed above)
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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.
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SUPPLEMENTAL
CQNSTRl1G�f
;LIEN LAN/ INFORMATION
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY: _
Name:
Not Applicable
Address:
Address:
City:
Zip:----_ ___ Phone
State:.
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work or recordin our Notice of Commencement.
01
'Signature of� essee Con a gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA t 1
STATE OF FLORIDA
COUNTY OFC.tQ _
COUNTY OF
The folIr��oing instrument was a nowledged before me
The forgoing instrument was acknowledged before me
this day of 20 by
this_ day of. 20_ by
1 r� yy-,or, Ae., N11�
Name of person making statement.
Name of person making statement.
r
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification r��7
Produced E
Type of Identification
Produced
,.IJLi
0y�
(Signature of Notary Public- Sttatf Florida)
(Signature of Notary Public- State of Florida )
Commission 20v 'U
No
sion No. (Seal)
of YSm,ELLEN VAUG
State of Florl�de-Nora
N
y public
REVIEWS
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VEGETATION
SEATURTLE
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COUNTER
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
CODATE
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Kev. 9/Lb/18