HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO GMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I� d S� 1 1 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
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Address:
SCANNED
BY RECEIVED
St. Lucie County
Building Permit Applic tiOrtEP 2 5 )o,q
ST. Lucie County, Permltting
Commercial Residential
Property Tax ID#: 3 1 1" 5-61 - 5-00I--orc7O- ^] Lot No.
Site Plan Name: 50wAPa4 101,91g- Block No.
Project Name: Pbri
Additional work to be performed under this permit - check all that apply:
1.
—Mechanical
Electric
Gas Tank
_ Plumbing -
Total Sq. Ft of Construction:
Cost of Construction: $ 900 0
Gas Piping
- Sprinklers
Shutters'
Generator
Sq. Ft. of First Floor:_
Windows/Doors
Roof Pitch
Utilities: —Sewer Septic Building Height:
OWNER/LESSEf:
C -Nil,R CTOR:
Name :e geld�L,, 5 L.LL
Name: .X
gar �nw
Address: 7 8(fl. )4; Jc
Company:
ti b"t o"
City: Porl-5✓ Lc, State: r(
Zip Code: 3 9I L33 Fax:
Phone No.
Address: .f 0 64-(a,7-0,76
City: l%Grr) (/3egc`
ZipCc(e:
Phone No �pp ?�-q%$
a. Stater
Fax: 7?P-kfp79-SU-D
S(o,S(p
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �; ar rAi ra CC>h
ir, r.i ;a . o r4 , . rrarn
State or County License
C G C is-/ (o f./ 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.
DESIGNER/ENGINEER:' _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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.-
Signat re of Owner/ L ssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5tr . e'\e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisaS dayofSe 20VA by
this�.9 dayof SnP� 201y by
b\`A�'OA�O d�gCq\Y�q
`
Q.n�'av\�G �%kGL Y\A
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L j� V
Produced
(Signature of Notary P lic-State of Florida)
EG
(Signature of Notaf #022023
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DATE
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