HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
— - Building Permit Application o�� � 10
Planning and Development Services pecmt n9 a Ctm of
Building and Code Regulation Division SCANNED St, Lu�ou
2300 Virginia Avenue, Fort Pierce FL 34982 BY {
Phone: (772) 462-1553 Fax: (772) 462-1578 CO�Yi TLwlejralounty Residential \�
PERMIT TYPE:
PROPOSED I/M/PROU€MLOCATIO ENT N:
Address: `( /� L°�
//�
Property Tax ID #: �-1 Lot No.
Site Plan Name: J Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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: Sq. Ft. of First Floor:
Cost of Construction: $ �e�d Utilities: _ Sewer _Septic. Building Height:
OWNER/LESSEE:
GONTRACIT R:
Name d/)&_/7 f f/_Pi.ceS
Name:
Address: ldD/z,Company:
City: 73/ Stata��
Address: -
Zip Code: a�S-7 Fax:
City: State:_
Phone No.
Zip Code: Fax:
Phone No
248L /1 (�j
Fill in fee simple Title Holder on next page ( if different
E-Mail
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.
SUPPLEMENTAL CONSTRUCTION L -N W I
DESIGNER/ENGINEER: _ Not Applicable
Name:
FORMATION:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:_
Address:
City: State:
_Zips_ _ 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."
X �, 0- ( A 4 2
Signature of Owner/ Lessee/ContractcT as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF rr: —
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this LA day of \ r� , 20L by
this _ day of 20_ by
Nameof person statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
IS I �lmO'y�Q1nM � / 1 r.s �UR i rn-
ignature of Notary Pub ic- State of Florida
(Signature of Notary Public- State of Florida )
Commission No. I°•.'"';_ L•4SH+4✓('bh'aE)^RArvi-RAHM�ING
Com ' sion No. (Seal)
L:Y <;GtAh1iS""'N * GG 276U6V
EXPIRES:[ ^�
REVIEWS
FR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
�)
DATE
COMPLETED
Rev. Z///15 I 1j /