HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: N 11q Permit Number: V _ o
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Building Permit Applicatior I JAN 04 2099
Planning and Development Services ST. Lucie Coun , Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PR'ROSED_INPROU.EMENTIOCATION:
Address: M
FL a 932
Property Tax lD#: �� �.R o• �dJ' LotNo.1J +
Site Plan Name: Block No.
Project Name:
DETAILED DESGRIPTION'OF.INORK
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CON STRUCTIO,NINF,O'RMATION:
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: �J Sq. Ft.of First Floor:
Cost of Construction:$ ().J® Utilities: —Sewer _Septic Building Height:
ES 'COW
s CONTRACTOR. x'
Name n N Name:
Address: Q a apa n rCompany:
City: r State: Address:
Zip Code: Fax: City: State:
Phone No.-nZ`- � (`�4 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
SU:PPLEIVIENTAL`CONSTRUCTION :LIEN LAIN INFORMATION:k .
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 ur Notice of Commencement.
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Signature of Owner/Lessee/Contra4oj as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF A. LkiGIe- COUNTY OF
The Tday
ing instru knent was acknowledge before me The forgoing instrument was acknowledged before me
this of � 2014 by this day of ,20_ by
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Name of pe on making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identfjcation Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida)
4y p�/I,� KA
%N& NIELSEN
Commission No. �o - State oa-Notary Public Commission No. (Seal)
=• Commission #GG 207484
My Commission Expires
June
REVIEWS FRO " O PRIOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.9/26/18