HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �`� `�
Date: Permit Number: I _ 1��1 1 V - 0 2,.L4'
_ SCANNED
St. ud CountV tit BY
RECEIVED
• -- Building Permit Applicati n SEP 13 2919
Planning and Development Services ST. Lucie County, Permit
Building and Code Regulation Division -
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
0
Lot No.
Block No.
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: _ND
�7
Cost of Construction: $ / y 75
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWN ER ,LESSEE:
CONTRACTOR:
=Wrne O
Name:
Address: 69c)9 nssi �3)6 ?
Company:
City: 4�)—Tie4c e State: FL
Zip Code: Fax:
Phone No. %12--,%29-g00q
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
it value of construction is 52500 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.
PRREWNWOMO
MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:_ _ State:
Zip: Phone —
City: State:
-Zip: - Phone: —
FEE SIMPLE TITLEHOLDER:' _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 priorto the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holderto 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 SUkBEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
- WITH'OUR.1-ENDER AOR N ATFOR Elif Y-BEORE RECORDING YOUR NOTICE OF COMMENCEMENT."
for Owner
STATE OF FLORIDA
COUNTY OF 14 ,
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The f going instru ent was acknowledge efore me The forgoing instrument was acknowledged before me
this ll dayof20by this _day of 20_ by
0 1 A -MINA. C�59->L641
Name of person making statement.
Personally Known OR Produced Identification"
Type of Identification
Commission No.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public -State of Florida.)
Commission No.
(Seal)
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