HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p�
Date: ��- J� Permit Number: ) n ]� V
RECEI"FED
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Building Permit Appli ation
JAN, 0 S 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: P�qf-{,�'I�t•1�
PROPOSED-INPROVEMENT.'LOCATION:Y ,
Address: clWi r I le- /fi('
Property Tax ID#: 0 3 `f oa- Gd ir- o!3 l - oyo 7 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF°V1/ORK.
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CONSTRIJCTION''INFORIVIATION: "
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:$ c1 fes. �'� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: cCONTRA CTOR
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Name Cht'L t R,ti� Name:MIMla.- 1�•..y��
Address: qrr myt j L pc. Company: Pro �� �;n�,c����►°� C�
City: State: Address: 17S� � C .
Zip Code: Fax: City: P. s, Lvc,C Stater
Phone No..77d; adg IV01— Zip Code: 1-5 Fax:
E-Mail: Phone No 7V 370 e16/
Fill in fee simple Title Holder on next page (if different E-Mail T c,n30 fdatuSj,•�� __
from the Owner listed above) State or County License C'&
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.
SUPPLEMENq CONSTRUCTION LIEN LAW INFORMATION—
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 thepermit 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.
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Signa re of Owner/Lessee/Contractor as Agent Signature of Contractor/License Holder s
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STATE OF FLORIDA - a STATE OF FLORIDtA.
COUNTY OF a COUNTY OF C.,9i d
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The fo oing instr nt was acknowledged bef The fng ins ent was acknowledged before e
this day of 2014by `gw thiso oiday o 20J� by
Name of person making statement. Name of person making statement
Personal Known OR Produced Identi Personally Known OR Produced Identification
Type of en ' i tion Type of Ide tifica t
Produced Produced
AJAIAI
ignature of Ncory Public-State of Florida (Signature of Notary blic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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