HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a.I Permit Number:
, RECEIVED
l fj_ s y
x:.
- - Building Permit Application
FEB 042019
Planning and Development Services ST. Lucie Countro Ngin9
Building-and Code Regulation Division –
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: Z
F re 'L
PROPOSED INPROVEMENT LQCATION
,.
Address: 94- t-6cca8e, 3455 1 ro
Property Tax ID#: 3 53 5 "10 – b 011 ��' "5 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
CX:
CONSTRUCTION INFORMATION:
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: $ q (00,�c Utilities: —Sewer _Septic Building-Height:
OWNER%LESSE'Ex fig, `' ` �3 :x CONTRACl"OR
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Name LJ Name: ixel 74- w
Addres . Company: OA r
City: State: Address:Z641 .ce. cw-la JA
,
Zip Code: S4.qJ- Fax: City:�,r , _rur State:—&j
Phone No. 4- (o C� – y,) Lo 2– Zip Code:c5,4 T'TZ- Fax:
°
E-Mail:���� j e, l U, � an, . c Lr,, Phone No
Fill in fee simple Title Holder on next page(if different E-Mail a c0j Ma S • e
from the Owner listed above) State or Cou14 License 144 99:= 7i
G
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.
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
commencinR work or recording our Notice of Commencement.
SignaturnF
er/Lessee/Contra or s•Agent for Owner Si Lure o o tractor/License Holder
STATERIDA STATE OF'F RDA
COUNTY OF SSC - L,3\K COUNTY OF A-.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �� .20� by this day ofs b ,20� by
- 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 ldentifxation
Produced I` Produced L
(Signature of Notary Public-State o gGNENs ;ti (Signature 'Qp,„ ,Public�sotAW4
DEANNpMN�► + MY COMMISSION# OV
a. �" N#GG U22U23 i D�ber 16 ZU?..f'
Commission No. i•• Co 16,?ozo Commissio mal
FXP1R S m b tarYPublicU� -
_ac ThN Notary
Bonded .
REVIEWS FRUIVI ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE-
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.9/26/18