HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ICI SCANNED Permit Number:
13Y RECEIVED
s _=�� St. Lucie County
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Ln
Y 3 0 2019
Building Permit Applicati county, Permitting
Commercial Residential_
PERMIT TYPE: l V �CC.w
1_PROPOS -D INPROVEMENT;.L'OCATION :":.;J
Address:
Property Tax ID #:
Site Plan Name:
Project Name:_
Lot No. �S
Block No.
CONSTRUCTION INFORMATION
{..
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: 1 CDO Sq. Ft. of First Floor:
Cost of Construction: $ Mo Utilities: _Sewer _Septic
—Windows/Doors
Roof Pitch
Building Height: IS -
:OWNER ;LESSEE ;. 4
CONTRACTOR
Name
Name:
Address:
Company:
City:11fl 90 1 n krib State:
Zip Code: Fax:
Phone No. :1-12 91 1 92 A
Address:
City: 7 State: R-
Zip Code: �34 Z— Fax:
Phone No—1-12-'-'33Z. WSO
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Y
1
State or County License
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.GONSTRUCTION°.LIEN LAW INFORMATION:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Zip:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 1 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 .,lf you intend to obtain financing, consult with lender or an attorney before
commencing work or reco 1 g vour Notice of Commencement.
ll A 1
Signature of Owner/ Lessee/Contractor as Agent Wr Owner
Signature of Contractor/License Holder
STATE OF FLORIDA L gyp'
�T �L(CU
STATE OF FLORID
�I IL4CIf
COUNTY OF
COUNTY OF
The ing instrumipnj w,,as� acknowledge before me
The f ng instrum nt was acknowledge efore me
thisGLD- dayof N/Illa1 20�by
Tl—
this dayof 20J Vby
�cnaVcl r� 1 �tti
Name of person making statement.
Name of person making statement.
Personally Known V . OR Produced Identification
Personally Known 'V OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State
i '
ur of Notary ublic-State of
Commission Now wm_
to*Po KATHERINE HAVENS
r� t'e$VGOMMISSION#GG165
EXPIRES: DEC 04,2021
KATHERINE HAVENS
mmission NO.(�A dly COMMISSION#GG16
///''' �n� Smov
J EXPIRES: DEC 04. 202Bonded
through lst Slate lnsurnce
Bonded through let State Itsi
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ZONING
SUPERVISOR
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DATE
RECEIVED
DATE
COMPLETED
Rev. 9/21i/18