HomeMy WebLinkAboutBuilding Permit Application All APPLICAB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i1 j �J • �1, t
Date: f Permit Number:
IN
FEB 0 7 2019
•
1. Lucle County, Permitting
Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: — !
•n _
PROPOSED INP OVEMENTLOCATION
Address: 32(o S.. E: f le QJ'l�J�� �� �1� ?Y�Y(o
Property Tax ID#: -02 (0 - Lot No.
Site Plan Name: P C)C-- - , CG e ((e, 'm-D (-rt Block No.
Project Name: _- P oa(= r::�Sa 6e k le m of r( S®fl
DETAILED DESCRIPTION OF WORK
R2, R0,01E Lit n a
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CONSTROCTION 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: 0 a 4cl Sq. Ft.of First Floor: Y�
T
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:.OWNER/LESSEE.;-CONTRACTOR:
:...
Namel le Name: 0-4 4
Address: 32,fo E-O e briye Company: pro r /rf!'a G7�2/t
City: (- i eTCe State:-E(, Address: 7 ne Cl/'C
Zip Code: Fax: City: f 0--11v-1 4G State:-f7�
Phone No. r7 7 7�--S-72-- �� ZO Zip Code:
.9? y cJq Fax:
E-Mail: Phone No b /- . /P c-D
Fill in fee simple Title Holder on next page(if different E-Mail 0 14 A 10 C'o�
from the Owner listed above) State or County License cec i 0Y
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 LIEN IAW INFORMATION r
�5 s
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/L ssee/Contractor as Agent f15-rWnW Signat=oaolLicense Holder
STATE OF FLORIDA STATIDA /
COUNTY OF_ &/1, � � COUNTY OF `0�(/ln A-94"
The forgoing instrument was acknowledged before me . The forgoing instrument was acknowledged before me
this 2b day of �n 20 19 by this /�U day of 3: jxzi 26 by
lQCCL50,11
Name of person making staternent. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced ! c J (l C2� (� Produced id fiV
1 CA,^5e Notary Public State of Florida
1 . Isiah Jorgenson.
g00 Notary Public State of Florida My Commission GG 209624
Isiah Jorgenson �la�► Expires 04r22f2022
{Signature of tary Pub - a F at2arto22 - (Si ature o otaryPu Ic- o
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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