HomeMy WebLinkAboutBuilding Permit Application Feb 19 2019 02:42PM HP Fax page 1
All APPLICABLE INFO, MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'``"\' ,–\ Permit Number: 2–t2610
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2.900 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
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Address:
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Property Tax ID#: � – Q�JJ 'C)O C)– Lot No.
Site Pian Name: Block No.
Project Name:
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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:$L (!�.�'� Utilities: _Sewer _Septic Building Height:
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Name Name: J__')b nQ..)dl: ? QyA
Address:l8?o!i TraLMudi it u BCS IQ.AA Company: .tri' . ct-Me
City: Fr P(C-k P_ Stater: Address: Re
Zip Code: O�Q NT Fax: City:f.L`oki M tM +&FtKh State:.
Phone No. Zip Code: 33L;C?q Fax:fWt- 7?-6kW?
E-Mail: Phone No :54 )•-&2QJ-10c�
Fill in fee simple Title Holder on next page(if different E-Mail L(C1V8. o ac krf ed(� ffi t'eA .C.ice(.
from the Owner listed above) State or County License K_'A C' 21 7160/p 5–
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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Feb 19 2019 02:42PM HP Fax page 2
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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/CONTRACTORAFFIDVIT:Application is hereby made to obtain a permitto 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 NOTICE OF COMMENCEMENT."
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Signature of-Owner/Lessee/Contractor as Agent for Owner Signature o Contractor/License Holder
STATE OF FLORJOA� STATE OF FLO D
COUNTY OF Z t� L,(A ri P COUNTY OF
The forgoing instru ntras acknowledged_before me The foPr�oinginstru nt as acknowledged efore me
this day of { 20fyby this_LJday of 20LY by
A n' P)ru U) /Di aid C' Arc.{m
Name of person making statementJ Name of person making statement.,
Personally Known ✓ OR Produced Identification Personally Known L,*'/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
m 2 -'e,
(Signature ofQ
ary Pu lic-Stat o N10010 L RomW (Signature of Notary Public-State of Flo
NOTARY PUBLIC NOTARY PU I
Commission No. STATE OF FLORI commission Na.� �5 �/ STATE OF FL A
Comm#00044529 Comm#GG
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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