HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �0 % SCANNED Permit Numb • �, N Q
ai r n St. Luce County RE R
-- ---- -- E DO
Building Permit Applic tion OCT 3 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Luciount FL
2300 Virginia Avenue, Fort Pierce FL 34982 yr
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _
Address:
Property Tax ID #:
Site Plan Name: A
Project Name: L
Additional work to be performed under this permit — check all that apply:
—Mechanical _Gas Tank _Gas Piping _Shutters
/(Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: / VIA
Cost of Construction: $ S00
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
GONTRAC-TOR:
Name �
Name:
nn
Address: oii,l �, _ ��-c �i / �i
Company:
City: f1 P)Crw, State:
Zip Cocle:zy9ge Fax:
Phone No. %26-3?7-5101
Address: -
City: State:_
Zip Code: Fax:
Phone No -
E-Mail:�11;1Ilea 4g2,gr o,;)•Cp�
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.
SUPPLEM -NTALGO 1 UCTION LIEN LA INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: ----Phone- -- — -- ---Zip:
City: State:
— --Phone: --
FEE SIMPLE TITLE HOLDER: _ 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 an 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 addition`s,
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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA —
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for ing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 17day of 20j6by
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
/
Personally Know OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identificatio 1
Type of Identification
Produced G
Produced
(Signature of Nota Public -State of Florida)
(Signature of Notary Public -State of Florida j
Commission N • ... REYB.H EY
Commission No. (Seal)
;! MY COMMISSION#GG300817
Bonded
Him Not Pis 0
e '
REVIEWS
ISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19