HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number. 12
:
RECEIVED
112�i
: FEB 12 2019
Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentialy
PERMITTYPE: ( CAS
aC ® IMPI , DEME �TIC�3
Address: 2'C)6 `E ss-e_�
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
E �p DECRI,P1'ION F ®RK:
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IBMR c�Ic IUFORM iI®N• ow
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:$. 10 06 Utilities: _Sewer. _Septic Building Height:
aE
t7W;w �R 'L.ESS �
Name CA-ri e-,�1-V(-'r iY\ClAi/,Z -Name: zd ,TH
Address: ) )16 JD� ✓6,,J 21, tne. Cs 0 Company:'���'✓'+ .1—i )-1 �`e�-.�_��G r� c. S�„r�/
City: Nf--% State:fc. Address: Jb O 1�!61�: A4 ` C7Zip Code: 3!j G1 4 b • Fax: City: M1t4k,4J L.j Stater
Phone No. . .b Zip Code:3.k ?6 Fax:
E-Mail: Phone No 6 b I—11 z i l-7
Fill in:fee simple Title Holder on next page(if different E-Mail C Jrn
from the Owner listed above) State or County License ALi s't
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.
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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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N TICE OFC MENCEMENT."
Signature of O ner/Lessee/Contractor as Agent for Owner Signature of Contrac or/License Holder
STATE OF FLORIDA k r STATE OF FLORIDA
COUNTY OF I COUNTY OF
The fo oing instr t was acknowledge before me Thefor ing instru ent as acknowledgVby
efore me
this+rL day of 20 by this day of 20
Name of person making statement. Name of person.making statement. /
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of ldentif ion Type of Identific
Produced Produced
AA I
(Sig ture o otary u ,KAIS NIELSEN (Signat re of Not ry lic=State of Florida)
State of F orida-Plotary Public
Commission No. `�= CoAea$on # GG 207 884 Commission No.
;a a: MY Commission Exp `��111YP,��.'
.taP v.,�
June '12. 2022 :2° :StaKe o 1:1,ENS NIELSE
Omrr ission # Gc�ary 1'u li
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION � #jj I RTLYY C)TULA4 f�RW 48
COUNTER REVIEW REVIEW REVIEW REVIEW un /2 res
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19