HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: w - 1 � 1 r Permit Nw
_ SCANNED
10 i: ` St. Lucie e County
Building Permit App
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE:�-
i: tion x
OCTI
16
Residential
Address: h /`fX -"�k jr6(16�8;w .U/ 1'j three Y4- 0��/�YC,
Property Tax ID #: 3-A1,2 - % lg- 00 D �- �n o-a ' Lot No.
Site Plan Name: Block No.
Project Name: (r V st±g! W9,1 �ti '
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers
sy
Total Sq. Ft of Construction: L15
Cost of Construction: $ 1,50o ,00
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWN -R/LESSEE:
GONTRA�R:
Name )rmV)'s
Name:
Address: of"-
Company:.. '
City: F4 Px e, State: FL
Zip Code:3Mq - Fax:
Phone No. _/jQj 3 3
Address:
City: '. State:_
Zip Code: Fax:
Phone No
E-Mail:%'S GaaP Ndstc...CUn^
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 $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.
SUP LEMEW CONSTRUCTION LIEN LAW INFOR
ATION:
DESIGNEI4 � p EER: f
Name: LnC,
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: In-r. r�
v-ti
Address:
City: er
Zlp`: 319fu -- Phone-
State
— 6= 79 —
City: State:
Zip:— --- Phone: — -- — -
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 restrictor prohibit such
structure. Please consult with your Home Owners Association and reviewyour 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
nun
Signature of Owner/ Lessee ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrum nt s acknowledged efore me
this day
The forgoing instrument was acknowl dged before me
of
J 20�by
this _ day of 20_ by
Name of person making statement.
Name of person ma/statent.
Personally Known OR Produced Identification
Personally KnownProduced Identification
Type of Ident fica
Type of Identificatio
Produced
Produced
(Signature of No - a rA r§dRlidPHR
(Signature of Notary Public -State of Florida )
COMMISSION #GG 300817
Commission No.
MY
• PIRES:(�1&6H6,2023
Commission No. (Seal)
.>,FOF �;°•'•' Bonded Thor Notary Public underwriters
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW EVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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A
DATE