HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONkil APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED
., BY
St. Lucie County
-o
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number: All
p.ECENED
Building Permit Application OCT 0 7 1019
Permitting de Department
untyenc
. Lu
Commercial Residential
•nnr•n'.,ee.ri'I n1oDl1\iCnA CnIT'I'rl(=ATI(lN '' .. + .. .,
Address: -
Property Tax ID #:
Site Plan Name: _
Prniart Name:
Lot No. —
Block No. (09_
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: ��31 Sq. Ft. of First Floor: 3
Cost of Construction: $ 30M Utilities: _Sewer _Septic Building Height: _
City: _ 1
Zip Code:
Phone No
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company:
%1]�iJlAi�'
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. ENTAL CONSTRUCTION LIEN LAW INFORMATION: ,
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
State: City: State:
City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
for restrictions which apply bit such
structure. Please consult withpyourr Home Owners Associationtlandrreview your deed any maor
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,
fences, walls, signs, screen rooms and accessory uses to another non-residential use
accessory structures, swimming pools,
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
commencing work or re rdin our Notice of Commencement.
Signature of 0 net/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID;)f STATE OF FLORI
I COUNN OF ����
COUNTY OF
Thefo oinginstr knowledgg�efore me Thefo oinginstr yKnowle2dOggdrbebfore me
this day of (I// ff
this day of 20 by
making ent.
Name of pe son making m n tateName of person atem
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Si of otary Public- State
f Frlda) KATHERINE HAVENS (
MY COMMISSION#GG165 30
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oars:... 11 THERINE HAVENS
MYCOMMMI SION#GG165030
(FRB
Commission NoYA71lY
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