HomeMy WebLinkAboutBUILDING PERMIT APPLICATION� � h
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: _����' Q 16 a
BY
St. Lucie County
RECEIVED
Building Permit Applicati n SEP i l 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 46211578 Commercial Residential
PERMIT TYPE: lk06 - G o WA
PROPOSED IMPROVEMENT LOCATION:
Address: M7 S, // S' F�
Property Tax ID#: 3�1y-SOl-«d�{-3a _(z Lot No.
Site Plan Name: Block No.
Project Name:
D TrAI LED DESCRIPTION OF WORK:
'7Z GXt pv
C4NSTRUC�TION 1NF9_RMAT1I*N:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_ Electric ' _ Plumbing _ Sprinklers _ Generator �of Pitch
Total Sq. Ft of Construction: �/-ro O Sq. Ft. of First Floor: i oO
Cost of Construction: $ .30, Uoo — Utilities: _ Sewer _ Septic Building Height:Alt
OR N E Vz I, E-s s E
ICONTRACTOR:
Name: 10nle c
Name X /A r/
Address:- ��0,3, Gc�O'YT� L11
Company: /!
City: c5 r State:%
Zip Code: 7% Fax:
Address:
City: 1- State:,
Phone No.7/�L-V;i !: f ]
Zip Code: 5: y 9 / Fax:
E-Mail:
Phone No d2 VO -0
Fill in fee simple Title Holder on next page ( if different
E-Mail /&� ! if? .-4l
State or County License r cc
from the Owner listed above)
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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 Iwill, 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 .OBTAIN FINANCING, CONSULT
WITH YO OR AN ATTORNEY BEFORE RECORDING YOUR NOM OF O MENCEMENT."
Signature w er/Lessee/Contractor as Agent for Owner
Signature of Co ractor/License Holder
STATE O FLORIDA
STATE OF LORIDp�
COUN OF S r, LN)C'.Q
COUNTY OF 5 LaI=tC
The forgoing instrument was acknowledged before me
�� Sep
The forgoing instr ment was acknowledged before me
this day of 20L by
this SA_ day of t D �h 20ft by
A 4ha ,,4
� vay.ev.d F ta�eAg
Name of person statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced 47 t.—
Produced NE:L L
AA
(Signature of Notary P lic- State of Florida)
GNF3�`
(, nature of Nota w"""M. a of�StdtU'�' ONd G029
Commission No. dam, `aN MAR10 �2p
(Sez µ 10N�i�y,21)
irtp,:Lu *. MY OOMMISS ppr Is.202�
.CR F mission No. �' DtP1faF-B'�ncUndpn^�'�
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