HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
SCANNED
BY RFCFI`FO
St. Lucie County r7CT2
Building Permit Applicatt` 91p/9
Luxe Co�Z eot
Commercial Residential
Property Tax ID #: �(1�— 00 tv— ( R )U A—) Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construc r `1 O V oV o
Generator Roof I Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
I -- ER/ ESSEE:-
CONTRACTOR.
Name .7 ' /% h f
Name:
Addres : C° Orn t�U
Company:
City: P L State: _I
,Z�ipCode: Fax: `ry'-
Phone No. (�/n l� )--.5S—S(O
Address: _ = ---
City: State:')
Zip Code: Fax: {"
Phone No -
E'�Mail:
All in fee simple Title Holder on next page (if different
di
oln the Owner listed above)
,r
r t
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is requuea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
UPPLEMENTAL CONSTRUCTION LIEN LAW INF
. MAtTION;
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 INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si" ureure of�ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �� ��
COUNTY OF
COUNTY
OUNTYOF
The forgoi g instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Zj pay of � C — , 20 ()by
.) nsz T(VrP S
this day of 20 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced FL OL
Produced
(Signature of Notary Public- ate of Florida)
(Signature of Notary Public- State of Florida )
Commissi �AG9�2 FI I FN VAUd�31)
Commission No. (Seal)
`�04PP
_i tate of Florida -Notary Public
'- Commission # GG 270079
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a.?� My o
Oct
mission Expire
b 22
�JPERVISOR
REVIEW
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ // 19