HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COnnr.ETED FOR APPLICATION TO BE ACCEPTw
Date: ^•L'-7-« SCANNED Permit Number: Q ��
BY
�.. �%CI
i - t. Lucie County
Building Permit Application NOV o 6 W9
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _X
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCAATIC
ddress: �D'l n Y_T'�LGS L7l,Q
Tax ID #: Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
A)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Block No.
_Mechanical
_Gas Tank
_Gas Piping
_Shutters
—Windows/Doors
Electric
Plumbing
—Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft oftonstruction:
Cost of Construction: $ 2', , 300 • 00
Sq. Ft. of First Floor;
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Cf}2oL o S2 A)
Name: Lau 5 C1o,o �S�
Address:,2Wl
Company:Qr f Al
city:,3'e State:
Zip Code: ;4L1 57'7 Fax:
Phone No. a 1f� i5_0 .3 d
Address: ,2�qaa gVrolar,'5
City: or 4 1 14 r e Stater
Zip Code: 'Fax:
Phone -No 21a AD`f y_71 7
E-Mail: CiRto`_ oL:Zh�✓��t +_tie
Fill in fee simple Title Holder on next page ( if different
from th6 Owner listed above)
E-Mail (Co o r\" R
State or County License cCac KOSY a
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 CONSTRUCT ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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.
1 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 IMPROYEIHENTS 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."
6e:.-Unat
Signature ff Miner/ L e/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF . . 10,LF
COUNTY OF
The Jorgoing instru ent��m yaT s acknowledgedpefore me
this day of V 20 by
The forgoing instrument was acknowledged before me
this day of . 20_ by
0 hApjl l . V,) 6 U33 4 11J
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Idendi tion
Type of Identification
Produced lY 1.
Produced
(Signature of Nota
(Signature of Notary Public- State of Florida )
Pnv ", < NIELSEN
ny
:x` ¢`�t�=State of Florida•Notary Public
Commission No.
= I�� 1•€ Commissi(ISealb(i 2o7asa
Commission No. (Seal)
My Commission Expires
'nn"`
June 12, 2022
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Rev.2/1/19