HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \a \A SCANNED Permit Number:
BY CRECEIVED
r St. Lucie County
• 7019
Building Permit ApplicatioPlanning and Development Services Pern
Building and Code Regulation Division _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address: S-1 10
Property Tax ID#: J(iOZ'(oIb_ c) 1S3-Doa13
Site Plan Name:
Project Name:
Lot No. C P
Block No. -76
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: 50--\ 'S!�, Ei .
Cost of Construction: $ C L afa -S- O
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name rep
Name:
_
Address: 1(� (ZQAc r-+(-•ee. l7-1
Company: r -
City: � 1 _ State: R
Zip Code: 3t(ct $Z Fax: p
Phone No. i� a- 3S�i - SOLO
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
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.
aci
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: -hone
City: State:
Zip�--P-hone:
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 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
nca.UrcuIna. I awn nu I n.c air
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sa-. \ pc t4
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledgeefore me The forgoing instrument was acknowledged before me
this � day of OC4 , 20 " by this_ day of 20_ by
i"Ao «r N& V. f t e +I\
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificat
Produced L
(Signature of No41.1111
EGNENS
MYCOMMI66K)NfIGG622623
Commission No.Arb. EXPIR&BIkem�16.2020
....,+.'f BondadT tbNotrry PU..* QMiWs
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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