HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number:
Planning and Development SLrvices
Building and Code Regulation Division
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
'DufAININED
BY RECEIVED
St. Lucie Countv UG 2 201�
AUG 2 8 2019
Building Permit Applicati n
s sT Lucl
cuL , Per
T. Lutiq County, Permitting
Commercial Y Residential
I PERMITTYPE: N I
��T�T�m
Site Plan Name:
Project Name:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
—Mechanical — GasTank — Gas Piping — Shutters —Windows/Doors
Electric Plumbing Generator Roof
Total Sq. Ft of Construction: 13-35 011:7-1 Sq. Ft. of First Floor:
Cost of Construction: $ lA0Q - ne, — ilities: —Sewer _Septic Building Height:
Pitch
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44i
NO 4-
Nameffltg Unlifd
Name: 1DR11 jLS )C i0l A
Address; Uo-,L
Company -
City: Jek�w L/ State:
-C
Zip Code: 3;?!J2- (ez Fax:
Phone No.
Address:
LiA!2 ',)E- 21151"Ln
City: 13e,11P i:ew Stateki,
Zip Code: ,-,W(4 rAD Fax:
Phone No352- -�04-5500
E-Mail:-
Fill In fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail Permite)
State or'County I icense' E, P-8 Q(5 to 815 3
If value of construction Is $2500 or more, a RECORDED Notice of Commencement Is requirea.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MOR GAGE COMPANY:
Name�
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: — Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_NotApplicable
BONDING COMPANY: —Not
Name:
Applicable
Address:
Address:
City:
ty:
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 priorto the issuance of a permit.
St.LucieCoun makes no representation that is grant g a permit will authorize the ermit holder to build the subject structure
which is in co %ict With any applicable Home Ownerstsocration rules, bylaws or anscovenants 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 exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
aWARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEMENTS 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 FINANICINC, CONSULT
WITH YOUR LENDER OR AN ATFORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENY."
as Agent for Owner
STATE OF FLORI STATE OF FLOR
COUNTY OF Pm2n�n I COUNTY or M"iot)
The fog . ng instrurrignt was acknowledg efore me
this_& day of r I/JBIL Tby
- NZ7—
b=is J new
Name of person making statement.
Personally Known / OR Produced Identification
Type of identification
Produced
Commission No.
NATA
The folpAi . ng instrum t as acknowledged efore me
this _Laday of __r �Yby
�Zm
Aomnf'<� �-Sourpu
Name of person making statement-J
Personally Known Z OR Produced Identification
Type of Identification
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