HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: /1-19 Permit Number:
RECEIVED
CQLINIT Y; ��
it JAN 1.-6 1019
— Building Permit ApplicationF,�rm,�,n9 eePartment
t
- Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
ecru c.co SUwe Gh
ee
PROPOSED`INPROVEIVIEN,I .LOCATION:
.,
Address: Sys ,
S ,, Lit)
Property Tax ID#: 3S'/9 $4o 022D OVOz Lot No. {�
Project Name:
DETAILED DESCRIPTION.,OF WORK:
TAT Lata... a lb L 1 ,- u. U) c.),A4.. . 4-o ere , 4450
CONSTRUCTION INFORMATION:
Utilities: _Sewer _Septic Sq. Ft.of First Floor:
Cost of Construction:$ 2,yet) oo�x� Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are,in the
floodplain:
Nonresidential Farm'Building Temp Bldg./Shed used exclusively for construction
Mobile/Modular for temp construction office: Bldg involved in distrib.of electricity:
Other " Flood Zone: BFE: Floodway?Y/-N If V.
No Rise Certificate with supporting data Attached?
Allother applicable state and:federal permits shall be obtained prior to commencement of
construction
OWNER/LESSEE:. CONTRACTOR:
Name bUtiliSii S iCf2 Name: /?2i4-4a
Address: el, di 31/3 Company: — 0 22
City: I111roPK -t State: Address: e�Pri, - S• -��
Zip Code: 3.I Lei" Fax: City: psi_ State: Pt
Phone No. 7?Z 3 Lic, 31a4 Zip Code: 31d14? Fax:
E-Mail: Phone No —712- 7-ti 72 2d
Fill in fee simple Title Holder on next page(if different E-Mail t✓lL iz/rt 44rO GU- 6. 944/ • t
from the Owner listed above) State or County License f9.-q5 2�
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.
SUPPLEMENTAL CONSTRUCTION,LUEN LAW INFORMATION -
DESIGNER/ENGINEER:. _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: i
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 wor or recon.i •'- r Notice of Commencement.
'--. :: -_,,•,.-,,,,,,,- ,
- -
- gnature Jf Oee/Contractor as Agent for Owner/'>i a •r- --O-ntr."-or/License Holder
STATE OF FLORIDASTATE OF FLORIDA c
COUNTY OFA (- COUNTY OF i.55--- �
The forPoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisI_1 day of J(Aj.) ,20 19 by this / day of CIG,n ,2011 by
l) (C,h0 lzglce_- intc) ma- LOf-e
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 L_
Produced 1-1.-- D L. Produced f L- S
(1 LiaL-11.: _____-____
(Signature ` -p�a�fl++�+�+ (Signature of Nota -
,a V1 ELLEN VAUGHN „04,,,i,„ ELLEN VAUGHN
AP
I+�'BC y :1430 -of;State of Flo otary Public
Commission r. ,State of Floods NG�r�g,Public Commission No. ,_.`, „ := OSI
:* *= om ion # G 7 0079 - Commissi n G 270079
Pc My Commission Ex ires ;+"�a''°`=
p ,,�.° °Qr My Commission Expires
-,,,'�ovF`° '''''i+`+`' October 2 2022 '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.1/9/2019
1