HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.All APPLICABLE INFO MUST BE CO ETED FOR APPLICATION TO BE ACCEPTS. -
Date: ��' �� SCANNED Permit Number:
BY
St. Lucie Countv
COUNTYRECEIVED
` Building Permit. Application SEP Y g 2[)jg
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) 462-1578 Commercial Residential
PERMITTYPE:
11116MA
Address:
Property Tax ID
Site Plan Name:
Project Name:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical
Electric
_ Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ i
_ Gas Piping
_Sprinklers
Shutters
Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
i
Name: I-}�
Address: @I(C-1.13
Company: ).�ItLJTf.�Cv
�L�4S
City: J _�:&'Q' State: L
Zip Code: QG71 Fax:
Phone No. `''2f.- Z - kl9 °I
Address: iS$1
City: ST t)c.'W_
Zip Code: 07 qcl P
Phone No �7'12—
State:%
Fax: -I'n _ "Z�j- (cl 1
- I Q
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailtZLN
4ks '
State or County Licens
If value of construction is 52500 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 CONSTRIra r-ION LIEN LAW INFORMATION:
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 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
POS ED ON THE JOB SITE BEFOREppTHE FIRST INSPECTION. IF XOU INTEND TO OBTAIN FINANCING, CONSULT
WITH)YOUR LENDER OR AN ATTOilNHY BEFORE RECORDING—YOUlb NOTI&DR rOMMEN[FMFNT_"
Signature o Owner/ Le
ontractor as Agent for Owner
f Contracto
se Holder
ST FLORIDA
t n�,/J ��
FLORIDA
I
COUNTY OF
P' `wit �
COUNTY OF ��
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The for oing instrument was
this)X day of S�TT
acknowledged before me
20J Otby
The f r oing instrum nt was acknowledged efore me
this a day of 20 _ �by
J
�
��
Name of person making st
ment.
Name of person maling
ent.
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of ntification
Type of Identification
Produ ed
rodu d
(Si nature of Notary Public-
nature of Notary Public- State of Florida I
e or'U" Nuotary Public State of lorioa
'
mmissionNo.
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Bharat
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ommissionNo.
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Greer Bharalh
or now Expires 07/18/2020
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19