HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAPi-APPL[tABLE-IN9FC)-MUST-BE-CC
Date: / 1•� /• %0
, ED FUR -APPLICATION TO BE -ACCEPTED
SCANNED Permit Number
BY
St. Lucie Counts,
NOV 21 2019
Building-Permit-Applic ' n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
"PROPOSED IMPR
O
VEMENT LOCATION.-'
Address: `01� 6�P � U) �ci T
i e a
Pro�ame•
\ `C 4N
IICONSTRUCTION INFORMATION;'
erm
St.
ring Department
? ucie County, FL
Commercial Residential_
Additional work to -be performed under this permit- check all'that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:) f�T_ Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic
Lot -No w
BlaieivNo)
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR::
-
Name QA CTIN e" \
Name:. \
.Address:X)I b t\Q
Lompany_, \C, D-VUC
S C 1
City: N \ C \-�\A State:
Zip-Code:3\_\QR0 -Fa�
Phone No. b o 3 \0 1 a%3
Address: 90y SV- C J-\
City: P, J(
Zip Code: � Lk Q 1II
Fax:
Phone No I`TD, 4g5 -
Stater
�o kN
c1OL T
`_
E-Mail: C V\JCk ev ca G. a�a. o C6\XX
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail C Cop\ het N `O'
oo o CO \N\
State or Cou ty License
SRa
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.
-sup
LIEN -LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: :Not Applicable
Name: Name:
Address: Address:
-0ty: -State: -CIty: -State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
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-c-ertify,that-no-work or installation-has-commenced-priorto-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:'
& (I a., lX1t_�
L
Si nature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OFF¢( P/
he forgoing instrument was acknowledged before me
The forgoing instrument w s acknowledg d efore me
�
his � day of �GCc 2 20, f by
this � day of N 6- 20 —by
�cwc.ck c�.E r
p;r, 30a�-
.N,
ame of, person makingstatement.
Name of person making sta a ent.
Known `10 OR Produced Identification
Personally Known r OR Produced Identification
d ers0nally
�lope of Identification
Type of Identification
Produced
Produced
(Signature ofN "ofy Public -State of Florida)
(Signature of o ary Public -State of Florida
Commission No. 6@7 � (Seal)
Commission No. ;io f-^•.>y AUDREIs�j Hu HREY
-(
YCOMMIS31�G300817
EXPIRES: March 6, 2023
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