HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ) 0 - SCANNED Permit Number: Lal/j/0-
BY
RECEIVED
St. Lucie County
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:
Address:
OCT 0 9 201P
Building Permit Application
Permitting DepartM"'
St. Lucie Cou^"
Commercial Residential 6_
PropertyTaxlD#: /3/2-600-O022 -000-&
Site Plan Name: Le S/b
Project Name:
Lot No. V
Block No.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping -Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:_
Cost of Constrrron,;$i�%Odo `� Utilities: _ Sewer _ Septic
_ Roof Pitch'
Building Height:
OWNER/LESSE :
GONTMMCT0
Name l�Jv /�sSe(rode-
Name:
Address/s��:570i ?/�teo R yr Cii
Company:
City: I-7 lelC2 State: FL
Zip Code: Ysf?S-/ Fax:
Phone No. -77Z.-35'9 37S'7
Address:
City:- - -_ '-T, State:_
ZipCode:- - -' 'Fax.
Fax:
Phone Noy.: I:
E-Mail: �nr; �f///9l x�P 4vyrarr! ttN�
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.
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 tobuildthe 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
YO LENDER O TT RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
eV.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
� Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
.Address:
City:
Zip: Phone
State:
City:.
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signatu a of caner/ Le ee/Contr ctor s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF .S% u[C/�
COUNTY OF
The forgoing instrument as acknowledged before me
The forgoing instrument was ackno� #edged before me
this � day of _Q�, 20� by
this _ day of 20_ by
Name o person making statement.
Name of person making atement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatiq� t�
Produced 1\—LJF✓
Type of Identifica ' n
Produced
� \
V /LlJ
(Signature of Notary Public -Sat of Florida)
(Signature of Nota