HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��
Date: SCANNED permit Number: tq� ,
BY
--_----! St Lucie County
RSCElVED
Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie count,
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
IMPROVEM
Address:
Property TaxID#: �/ O�7rff'o�OZ' I�c� !3U \> >UPetAYe��
Site Plan Name: Block No.
/ Project Name: O&./
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: // // Sq. Ft. of First Floor:
Cost of Construction: $ �Ydd Utilities: —Sewer _Septic
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:,
Company:
City: T1 ve'. a State -2�-/-
Zip Code: i<`bl�3 Fax:
Phone No.
Address: 1e16=�
/
City: 'U�fe1�F�/ StateJ'�
Zip Code: <3371.�Q Fax:
Phone No -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail QP/nu'g' r
State or County cense Z,----;?,: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:
DESIGNED ,ENGINEER•
Name: rihtry.lilrC
_ Not Applicable
P g
MORTGAGE COMPANY: of Applicable
Name:
Address:
Address:
City:�h4,ll2 Fo./
Zip:,��Phone_
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
otApplicable
BONDING COMPANY: otApplicable
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
"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."
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Signature of Contractor/License HolderSTATE
Signature of Owner/ Lessee/Contractor as Agent for Owner
OF
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OF ORID/�j��r
COUNTY OFORI9
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COUNTYOFSTATE
The for oing instrument was acknowledged before me
The fo�rPPoing instrument wits acknowledged before me
this day of u 20 /�[r by
this [� day of 201Pby
, //�
Name of person making statement.
Name of person making statement.
�OR
Personally Known Produced Identification
Personally Known °' OR Produced Identification
Type of Identification
Type of Identification
Produced
duced
Notary PubNc State of Flaritla
�d"W� Notary Public State of FI
Jennifer R Ronnebur
Jennifer R Ronneburger
o` My Commission GG 227212
_ • My Commission GG 227
gn [u of 'Not"ublic- to lore
na ur f otary lic- tat
Commission No. (Seal)
Commission No. (Seal)
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COMPLETED