HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: `dv��)J 0�d
RECEIVED
7_12
JAN 0 3 2019
Building Permit Applicatio
Planning and Development Services ST. Lucie Countvs Pptt.T`iittin9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: �
PROPOSED IMPROVEMENT LOCATION:
Address: .SI L-V& .STt .-PAC r"
Property Tax ID#: /y33 — UP —0 0e,GI 0®d l Lot No.
Site Plan Name: ` Zj c, Crag Block No.
Project Name:
DETAILED DESCRIPTION.OF WORK:
6-&S'TDr e_ 100 0 0--r L eii rl{T ���
01
CON STRUCTION IN FORMATION:
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 300 Utilities: —Sewer —Septic Building Height:
OWNERAESSEL;:, CONTRACTOR
Name 'rt o'lp I-eiful Name: N: .>[7'
Address: 6 2 O S 1 I V&. S TrrgZAPn Cir Company: C. _Qw r 7h/ CLe e_fP, c,n c ja:Q/
City: r /' _ State: t--C. Address: e-T
Zip Code: 3 k Fax: City: M.(wryP_at-'n State: FL
Phone No. Zip Code: 31`71 6 Fax:
E-Mail: Phone No Jr�GZ �i'xA1 ( 7
Fill in fee simple Title Holder on next page (if different E-Mail 222 'i/� 5P�'✓IC,P c.
from the Owner listed above) State or County License t 3,9 h!�:� 9
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.
Jo
ti
SUPPLEMENTAL;CONSTR'UCTI ON LIEN LAW IN'FORMATIOW
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Le see/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDS� STATE OF FLORIDA .
COUNTY OF % Lyc\ 5k COUNTY OF b}. L\)c\A,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of 20_\� by this % day of ,20A by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificadon Type of Identification
Produced L L Produced IF-k' Q L
to
(Signature of Notary P lic-State of Florida) (Signature'of Nota
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Commission No�(1 ASMo GG62 23 Commission No 13�s•• P��Spre�Yp
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REVIEWS FRON SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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COUNT REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.9/26/18