HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3�� ®� Permit Number: \`�id3d�Q3a'
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ECEIVED
�t
AR 01 2019
Building Permit:Applicatie�og(ay. Permitting
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: e on`
PROPOSED INPR011'EMENT �OCi4 ON: ,
�.
Address: ICAOU End1c(a— -182-
Property Tax ID#: a. `a�' rD d Od�S �4O^ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
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re-.er ab- c Co nc t-�e on l ` a
41 in OW A- 5—1— 500 k�z s
CONSTRl1CTION INFORMATIOW"
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: v Sq. Ft.of First Floor:
Cost of Construction:$ o V V Utilities: _Sewer _Septic Building Height:
a x m
n � �
ouNER%a.�SSE �� R
�e NT, ACTOR
Name rCA6udieto Name:
Address: I qDU YAW 06t l Company:
City: ,& L(M State:FL( Address:
Zip Code:3!eNOl Fax: O r City: State:
Phone No.-1-1Q. -405- `5SLp T Zip Code: Fax:
E-Mail: Car me n D 328 cn P MZ1.0> hone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 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.
SUPPI:EMENTAL CONSTRUCTION LIEN LAW INFORMATION;
, A
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 Countymakes 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
commencift work or recording our Notice of Commencement.
Signa r of Owner/Lesse Contractor as Agent for Owner Signature of Contractor/License Holder
STATE F FLORIDA STATE OF FLORIDA
COON OF S �-y�`'� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \ day of Yn� 201A by this day of 20_ by
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 Identification
Produced Produced
r
(Signature of NotaryPublic-St (Signature of N'otary'P•ublic`-State''of Florida )
.�'pv"b,"'% DEAN MARIE GIVENS
#GG 022023
Commission No.c - 3MYCoM I�� Commission No. (Seal) .
;o EXPIRES:December 16,2020
�rFOF Bonded 7tuu Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR- PLANS` VEGETATION SEA-TURTLE ' ' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE "
COMPLETED
ev.9/26/18