HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: C
RECEIVED
FEB 112019
Building Permit Applicatia unty, pe�rmlttlng
Planning and Development Services ST
Building and Code Regulation Division L
2300 Virginia Avenue,Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
Address: 30-/
Property Tax ID#: _'0001 ' 0,06__T Lot No.
Site Plan Name: Block No.
Project Name:
`;DETAILED
FV
_�'I'PT, 09X
;CONSTRUCTttJN
AFORATN 'M
10 N!
Additional work to be performed under this p4knit-check all th6t apply:
06anical Gas Tank l5as/Piping Shutters T Windows/Doors
Electric Plumbing Sprinklers Generator Roof Pitch
Total Sq.R of Construction: Sq.Ft.of First Floor:
f1d:
Cost of Construction:$ rpe Lftilities: —Sewer Septic Building Height:
NameM J. I-lo,-z S OF
a. 4- 14 4 Name:
Address: Z bf?,� 42
Company.]
city:z� A&re State/I-" Address:
Zip Code: _Wfrl? Fax: City: 4QE!6;1'_ —State: "Ore-
Zip Code: Fax: 712,542,�G 73
Phone No.
E-Mail: Phone No
Fill in fee simple Title Holder on ne if different E-Mail 494AW.,ta
from the Owner listed above) XIPT�7 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.
ON N: �,JN, 01.
SUPPLEMENTAL L-C. STRU
DESIGNER/ENGINEER' If Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: Stat
Zip: Phone Zip: Phone:
4
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 your Notice of Commencement. A
U
2?
Signature of Owner/Lessee/Coniffctor as Agent for Owner Signature of 66ntragor/License Holder.
STATE OF FLORIDA STATE OF FLORIDA /
COUNTY OF COUNTY OF Y7- elelc-le
The forgoing instrument
was acknowledged before me The for Ing instrument was acknowledged before me
this day of! ,✓
20_ & by this day of 20 by
Name of person making sptement-J Name of person making statement.
Personally Known / -OR Produced Identification Personally Known 41/1011 Produced Identification
Type of IdentificAlon Type of Ide ca
Produced—!i;- Produced *&
Caitlin Cole
NOTARY PUBLIC
STATE OF FLORID;
r it LA
{Signature of Notary Rullfir- I Wnat7off Notary Public-State Wo
Expires 211212023
K AOR
tate f
C om mi
M M
y Co
KAREN
44. NIELSEN
Commission No. tate of a-Notary Publi Commission No. 0 (Seal)
Commission #GG 207484
Y Commission Fxr1irF4_q
I June 12, 2022
REVIEWS IF ONT__701=111_000- --- PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED T— 1
DATE
COMPLETED
Rev.9/26/28