HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1,
r^.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (h ` I Q SCANNED Permit Number: I� I l J - (I OI
BY
St. Lucie County
LRECEIVED
Building Permit Applicatio
Planning and Development Services
ermit
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial- - - —Residential------- -
PERMIT TYPE:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
SO
R()5Et3
DETAILED DESCRIPTION OF WORK:
L-P
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Lut4h acts s
Additional work to be performed under this permit —check all that apply:
_Mechanical ✓Gas Tank L.,'6as Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction: `-r Cost of Construction: $ ob
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESS E
CONTRA OR:
Name
Name: R-A&I-Li
Addre •
Company:
R. P oC4 ww;
City: 1r (,F (/L,� State:
Zip Code: Fax:
Phone No.
Address:410 5t: SA Qi (\p
City: (t� State-1 —
Zip Code: 34act Fax:
Phone No —7 2- a a0 a I
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
gig
E-Mail LJI42
1 (2-4 M R i l.. • C OlYN
State or County License
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ 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 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: roam additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"YARNING T9 OPYNER: UR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROY ENT O YOUR PROPERTY. A NOTICE OF CEMENT MUST BE RECORDED AND
POST ON THE JOB IITE B ORE THE FIRST INSPECTION. IF Y TOO AIN FINANCING, CONSULT
WITH OUR LE DE
ATTORNEY BEFORE RECORDING YOU NOTICE F/COMM�CEMEM"
i
i
Signature wner/ Lessee/C r kor as ent for Owner
Signature of ntractor/License H er
STATE OF FLORIDA
STATE OF FLORIDA p
COUNTY OF . Lj (',(F _
COUNTY OF `M A ci� I &J
The forgoing instrr n k was acknowledge before me
this L day of l t l ' J 20� by
The forgoing instrujnent w?s acknowledged before me
this day f 9 20" by
2i\6
Name of person making statement.
Name of person maktement.
ing st
/
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced )
Produced
.....fi'
R,
A, 3-AA
.yip`
(Signature of
(Signature of ry Public- 4te
CommissionfFA
"a<:KAREN S. NIELSEN
s state of lorida-f1SPa"it) Public
Commission No. 00ue
Commission N GG 2074840*4
My Commission Expires
REVIEWS LL
June
OMIT VISOR
PLANS
VEGETATION
S
OVE
FKUNI
MMN=
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
RE6111111
EVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ 7/19