HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr'
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3\ Iq SCANNED Permit Number:
BY
St. Lucre County
RECEIVED
Building Permit Application
Planning and Development Services JAN 31 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMITTYPE: Roo�in
PROPOSED INPROVEMENT LOCATION:
Address: 6114 US 1415
1 Wail I -
PropertyTax ID #: 34QS ->rOa_ b Q -100 -(e Lot No. ab to
Site Plan Name:
Project Name:
Block No.
I DETAILED DESCRIPTION OF WORK: I
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I 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 V Roof I 1'Z Pitch
Total Sq. Ft of Construction: $4'i0
Cost of Construction: $ L 14 00, CO
Sq. Ft, of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name balr ` vf.S
Name: LAre.McAwrIA
Address: lalg4 S. US "%I l !,15 1
Company: Waoq
City: t=or46 pie o,. I I State: VL
Zip code: 34Wis9, Fax:
Phone No. 9 9cl - iko5- 031ao
Address:_ l_uaRo9u V'dlom Co Aulcr I- #23Z
City: Poc4-S+11.}0.J State: FL
Zip Code: SIKZrl Fax: 9"71-156-ogm7
Phone No_$ J-I - 4017-3S 35
E-Mail: A 1e @ 1ouArl.,c h�� ajc
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail l-Mc0aA(1d GSojFheastcovrh-achna . can
State or CountyLicense CCc 1330o D•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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: NJA
MORTGAGE COMPANY: _ _ Not Applicable
Name: wf A
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: M�A
BONDING COMPANY: _Not Applicable
Name: NIA
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S�UAL�&,
COUNTY OF SE Lucre
The forggoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this Itidayof20�`1by
thisak_dayofJanum,j_20_by
Lni'AA IY1cr .Ca rA
Lwn., M cel onat c�
Name of pietson making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida )
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Commission No.��Lp�� �)MY COMMISSION dFF
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EXPIRES: Mayt6,
EXPIRES: May46,2019
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