HomeMy WebLinkAboutBUILDING PERMIT APPLICATION6rcl
All APPLICABLE IFOAM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: S
CByNED
Sr Lucie Count,, RECEIVED
a
-- Building Permit ApplicatiEnNT�! 2 O'019Planning
and Development Services ie County, permittin
Building and Code Regulation Division g
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
!1155
� • SED I.M 99ME EN LOCATION:
Address: db k' J-(n
Property Tax ID#: Lot No. -7&
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION O WORK.
-
C 1 -dsnl
CON RUGT10N 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., 9 ' Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Costof-C"o a uctio;�=$ (-)OUtilities: Sewer Septic Building Height:
OWNERZOESS -E:
CONTR CTOR:
r� m !L Cl
Name:
Address: I
Company_
Cjty: -F W Are Stater
Address:..
City:
c
zy-57
Zip Code: Fax:
Phone No.% 12 go-)-B - I
Zip Code:' Fax:
E1Mail: VUlAe
F�ILin'f f i ple Title Holder on maid 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.
re2 &9-6 M
SUPFLEME TAMaGMS111110
lGI IEN LA 1
FORMATIO
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 inconflict 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."
gnatu d ,own. �,, L Contractor Agent for Owner
Signature of Contractor/License Holder
o ss as
STATE OF FLORI A
STATE OF FLORIDA
COUNTY OF L-U(�/�
COUNTY OF
The forgoing instrume t was acknowleNedbefore me
The forgoing instrument was acknowledged before me
this .C/..�d�aOy�o/fps m//(((� 20" by
this day of 20_ by
gy
T 1 , 1
Name.of person makinjstkemeFh.
Name of person making statement.
/
Personally Known OR Produced Identification ✓
Personally Known OR Produced tdemtification
Type of Identifi ' n
Type of Identification
Produced L r
Produced
(Sign ture of N ihli�riS}_atof Florida I
(Signature of Notary Public- State of Florida )
�.">a, KAREN $$�_(N����LSEN
Commission No. ;:° ' $tflt>rof Floritl�`i9VL Public
Commission No. (Seal)
y •e Commission # GG 2074E4
o?.' M Comm"
June 12, 2
22
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