HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONLJ d. A
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y\s� �� SCANNED Permit Number: `��yJ0113
- ..... BY
"t Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: `\W,r o-,1 cg,-V o
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name: _
Project Name:
DETAILED DESCRIPTION OF WORK:
Commercial Residential
Lot No.
Block No.
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �. 500 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: %5imJCl VOLS
t7g
Address: 2I`1-1 E lea- Z3Ivd
Company:QFlano�tJe
R dut .�
City: Si-uac'A State: KL
Zip Code: 349g1 Fax: 'I rloL a.10-5313
Phone No. `t—I i), — o)$ (— ) S
Address: 3211 Gp(dg-r
Cg" 41sla
City: rJwkes
Zip Cade: l i7
Phone No ;tSq '
State: ell
Fax:
S r%D%D
E-Mail S p �a5ecac �_ o r' �a r iceL"^v� ccs^�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0oC4A('.-F1 C&
QC
- Corn,
State or County License
C G Q. PM o 11'l
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:
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.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count 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 see/Contractor as Agent for Owner
Signat�s ontractor/License Holder
STATE OF FLORIDA
STATE FLORIDA
COUNTY OF iYl0.f�� n
COON OF PA_ a 4-t a
The forgoing instrument was acknowledged before me
thisdayof Apr, I .20_ft by
The forgoing instrument was acknowledged before me
thisq* day of Apri l .201I by
SllerrU i1
vei-snue-- ,r
Name of person ++making statement.
Name of person making statement.
Personally Known OR Produced Identification X
Personally Known OR Produced Identification X
Type of Identification
Produced arrvers IlcenS�_)
Type of Identification
Produced AV-1�ra Ilcens�_
ignature of Notary Public -State of FloFro
(Signature of Notary Pu
Commission NO. e� NOWIV QIT of7Fl..dCOmmIS510n
• Deborah J text'MyC
My Cormmmni n GG 2
Notary Public Stale of Florida
NO. Debo �wy
GG 258583
p Expires 09/0812022
•
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ev.217/19