HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL D FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie Countv
a
�—I Building Permit Application RECMED
Planning and Development Services OCT 17 7019
Building and Code Regulation Division j Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 r St. Lucie County
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSHD IMPROUE_MENT
fLOCATION:
Address: ��g �SGd SrII
Property Tax lD #: O tJ � (S �� ^ S Lot No.
�t2
Site Plan Name: CL c A Block No.
Project Name: LL CA
DETAILED DESCRIPTION OF WORK:
•ONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ PlumbingSprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: N V Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _V15eptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name rr o - u Name: W40
Address: CI U5 L, 1r/r Company: af.
City: State:F�- Address:tt'�B�VI �+ rgluLi
Zip Code: 33y-7c1- Fax: City: r'r 1 "mac State:_
Phone No. - 6 - 6 i S s Zip Code: 34 cl S) Fax:
CR
E-Mail: uV cMtn .S C. Ca . Phone N 7a � �1 7 7
Fill in fee simple Title Holder on nex(t age (if different E-Mail
from the Owner listed above) State or County License C IYL �(D
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.
`• •as
City: State:
Zip: Phone
FEE SIMPLETITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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."
I A Y
/,1 J 1/6
Sign ure o wrier/ Lessee/ ntractor a Agent for Owner
gn re cf Cont /License H Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledgQed before me
The forgoing instrument was acknowledged before me
n
this I-) day of 201� by
this A.day of c- 2q�_ by
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
Produced
hN n
(Si nat re of Notary Public- S to of Florida
(Signature of Not .WbRitpXg 'd-RAHMING
:'
Commission No. :; �"�;"••; LASHI(GRAM-RAHMING
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Commission No. •a= IRES:Decdtd%P2b,
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MYCOMMISSION#GG275060
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EXPIRES: December20, 2022
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ev. 277719