HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COiviri.ETED FOR APPLICATION TO BE ACCEPTED �^ rl r
Date: Permit Number: `O S -041"
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St. Lucie CountyWtf
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- - - - --- -- Building Permit Application ,
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Planning and Development Services
Building and Code Regulation Division a
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
;PROPOSED IMFROVEMENT,LOCATION`,Ili J
Address: 400 UI-D DI A-1 I- i-lWY
Property Tax ID #: 1 to '1- 13 4 - 0001- 000 - L Lot No.
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTIOIV_OF WORKSi
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Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank Gas Piping _Shutters —Windows/Doors
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Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ i J
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER%I
ESSEE
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:CONTRACTOR
Name US 'E; tOT GOA4M c0
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Name: ✓_Ei.NIUST-A A• G- RC041A Tk
Address: JCL $01- IZAt 3
Company:C�V'xFi_CD 6ir JkAL 6avey4ewrr
city:SNgwrlfr✓ MISSION
Zip Code: WL $r 2— Fax:
Phone No.
State:
Address:5W4uJ E~PPafa: Pa
City: PS C_-. State: �L-
Zip Code:3cfq f % Fax: 772-3yP-7rf7.f
Phone No 17-L-3110-11/7 V
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail dot c`Pl7e @ C-i'"FLcO. L.Dr-t
State or County License 13003gl S'
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.
SUPPLEMENTALCONSTR
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INFORMATION
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_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.
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."
Signature of Owner/ Lessee/Contractor as Age t o- Owner
Signature of Contractor/License Holder
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STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoinginstr instrument acknowledged before me
this � day of �( 20a by
The Agpingiof entyrp_ was acknowled before me
this ��day of (/�h � 2 by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known c__� OR Produced Identification
Type of Identification
Type of Identification
Produced
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(Signature of Notary Public- State of Florida j
(Signature of Notary Public- State of Florida j
Commission No. ;°�°""•" ;•; a PAMWASCOINI
I100, OMMISSION#GG 1321
C mission No. Y .....
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EXPIRES: August12,2021
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REVIEWS
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