HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L q Permit Number:
RECEIVED
a
Building Permit Applicatiori MAR 0 9 2019
Planning and Development Services ST. Lucie Coun y, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
I'R47w�3 E'D1N, 4 1E11lIENU Cq 1+D mu a x
Address: �� r^
Property Tax ID#: Lot No.
Site Plan Name:
-A lez- 142oa�3-aa� r
Block No.
Project Name: 9'A
�1ih'
w5t
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:$ Utilities: _Sewer _Septic Building Height:
Kix a
C? . 1 ER/LESS ( R: N
Rte.
Name U-i!M SA-n or,'h hn I"e Name:
Address: ofilq h < Company: "afra
City: Pyr- s C E`er - - Stat Addrests^._ ``/® -- 1f �� �� PA
Zip;Code: ��!! Fax:' City:;t-/� ��� [(= Stater
Phone No:" 1l*� !�5' Zip Code:
E-Mail:��n ::`I=.`x(`12/4-atll� C" Phone No 7 I -772
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) Sta e r Coun y License
a��
If value of construction is$2500 or more,a RECORDED Notice of Commencemd nt is re ired. �
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPP'LEMENTAI CC3NSTRUCTIQN E LAW INFORMATION:
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.
P"t-n A
Signat re of Owner Lessee/Contractor as Qgg nt for Owner Signature of Contractor/License Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF STS L,C,`e
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of /�11_ UU�`C� 20 by this day of 61 j220il by
Name of personmaking Cement. Name of person makA�sementPersonally Known OR Produced Identification Personally Known R Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary
Pt li -St of Floris da) (Signature of o y Public-Sta of Florida)
DANY XV
Commission No. :.: ._ MY COMMIS 59@UF 198907 Commission No.
EXPIRES;June 12,2019 ��c� �Rt NES ,
f;;f;°"' Bonded Thru M1^ary pct c Jndt^+ite `•• :*' MY COMMf3SI0N N FF 196907
i
q;� '•` Bonded Thru Notary t a5!ic underwriters 18
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 9/26/18