HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \dTSCANNED Permit Number:
u� BY RECEIVED
I. St. Lucie County
- _ — Building Permit Application OCT 2 5 2019
ST. Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
=IRMITTYPI:'t``�fi
PROPOSED IMPROV ,ME-NT LO • TI0
Address: %I0 0�4(-Ll Lr
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
D rAILED DESGRIPTION MF WORK:
do(.k %Qt
GQ R GAT ON INFORMA RN-.
Additional work to be performed underthis permit- check all that apply:
—Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
`X Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ A/ '466 Utilities: _Sewer _Septic Building Height:
OWNE- (LESSEE'
GOT OR:
Name T, i1 htgltM'LV
Name:
Address: G�SQ,
Company: Isa�^�GI� S1�4S Ifiiti Q2J �d
City: r- O r•A i p i P r G' �p� . State: %, L
Address: VR W n) t/ lAc,: 4e11 G!
City: I-L(ck State:�L'
Zip Code: Fax:
Phone No.
Zip Code: 59 q n Fax: �7Z D3�r1
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail L- 51�2a k-a ra O , c6m
State or County License
from the Owner listed above)
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.
q �5
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip_ Phone
City: State:
Zip: 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 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 INVND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE AF,dOMMENCEMENT."
_
V
Signaturb of O ner e e / on ractor as Agent for Owner
Signature of Contracto /I is nse Holder
STATE OF FLORIDA
STATE OF FLOR
COUNTY OF S-Ir . �-Oe ��
COUNTY OF eve � e
The for Ding instrument was acknowledged before me
The for Ding instrument was acknowledged before me
G�--'t
this`I-� day of 6 c� , 20� by
this' day of , 20N1 by
Q o.te c 1�'01. 3•%\+vs
��''t- c ., -1._ S'%>a S
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Type of Identification
Produced_ L-
Produced %�v L *L
`}\L�'P
(Signature of Notary Pu ic-.State of Florida j
Signature o 4�brl�ic- S� Nifiq� y
1\ l6 20�tc
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Commission No. G
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mmission t Not"
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Rev. 2/ i/ iy