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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION6 rA RON All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED - 1 Date: CX�1 �9 SCA Permit Number: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fart Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMITTYPE: W,. Address: %D "/ o(..0 Jfk24VVk_, PropertyTax ID #:- Site Plan Name: Project Name: ©ETAILED DESCRIPTI©Ni©F W©RK@; - NNED _ BY RECEIVED St. Lucie County Jul""',Building Permit Applicati snT Lucie County, Permittng Commercial K Residential Additional work to be performed under this permit- check all that apply: _Mechanical _ Gas Tank _ Gas Piping _Shutters _Electric _Plumbing _Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ 6; 6 /40 Lot No. Block No. _ Windows/Doors Generator —Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNS /LESSEE: Name Ao Name- - Address: rJ % iU Company: C: City: T State. Zip Code: 6 Fax: Phone No. �% /� Address: City:- q �I Zip Code: A qld a. Fax: hone No Stater E-Mail: CL4j/Y10/'/2oo D AVAI FAP�O,CU Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State or County License -S'/ S n vdme uj cunsrrucuun is ;,zouu or more, a newnueU Notice of commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. Sh1RPLEMENTAL CONSTRUCTI;©N LIENI LAWR INFORMATION; e DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: Zip: Phone State: City: State: Zip: Phone: FEE SIMPLE TITLEHOLDER: Name: _ Not Applicable 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 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 "!YARNING 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�FINANCING, CONSULT LC - WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTI6F [FMFNT_n STATE OFIF90RID COUNTY O2 Thefo inglnstru this day of Name of person maki Personally Known J Type of Identification /Contracto s Agent for O% l acknowledge efore me 20 by L�vD tement. OR Produced Identification (signature of NotaW Pubes- State of Florida ) wM Commission N �*"'v Notary Publio Stapbtmpnda L Crosi yam:_ + My Commission GG 156686 REVIEWS 0 T ONING SUPERVIS COUNTER REVIEW REVIEW COMPLETED STATE OF FLORIDA,n COUNTYOF_ IcEGl j' 0,efrei- The fofgging instrume was acknowledges efore me this ay of 20 / by Name of Iprson making tatement. Personally Known r7 OR Produced Identification Type of Identification of Florida) 156686 REVIEW REVIEW� REVIEW I MREVIEWVE