HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �. Permit Number: IqDT q
RECEIVED
MAR 2 9 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 Residential
PERMIT TYPE 0
I' OPUSED RMPMAW 11WA7W10: //
Address: 2-`�d�P Q��J�e� L401mmo _ Lgae
PropertyTax ID#: `�C(��Lf ]Q Z, D 0 6 OCA Lot No.�
Site Plan Name: Block No.
Project Name:
MTHM BMCRIPTWl W WORK:
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�Pi'Ino �p�e L;ny rrx I-to 45s o S s 1Q C2 W,
Sco&t U I' W n�f.
CONSTRUKNONJONSIP1,190MTION:
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:
OWNER/LEcWREE: CONTRA OR:
i
Name ftko rName: o L(L SD f, G
Address: �(y�p l�iile� l ` ivirMoelL. Ll>1 Company: `efc 4
-Z Y'L_ Add'ress:: /U.l.,� ' UGSS4L.
City: v .�= �� tr C State:
Zip Code: Fax: City: Po C-("t.; State: )--c,
Phone No. ��2: Zip Code: Fax:
E-Mail: Phone No .Z _ �0 -d 37U
Fill in fee simple Title Holder on next page( if different E-Mail t-5 l uots I( ctG Lsj h)
from the Owner listed above) State or County License C G
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.
SUPPLEMENTAL @M TRrUCTION LIEN LAW INFORMATIO
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 TIE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU I TENDO OBTAIN FINANCING, CONSULT
WIT UI C DR OR AN ATTORNEY BEFORE RECORDI G YOU N � OF/CO MENCEMENT."
Signature of Owner/Less Contractor as Agent for Owner . Signature of Contractor n e Holder
STATE OF FLO IDA STATE OF FLORIDA f
COUNTY COUNTY OF
OF
The-forgoing instrument wa acknowledgEq before me
The ing instrum nt was acknowledged before me thi day of ` ' 20� by
thiday of 204 by 4!R�VA 0,IL
-3��a E�a Lill t-As L
Name of person making statement.
Name of person making statement. /
Personally Known OR Produc dentification 1/
Personally Known OR Produced Identification Type of Identification Produced
Type of Identifi Qn
Produced (.
I (Signature of Notary Public-State of Florida)
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(Signature of Notary Pu I' - """'
KAREi�I S. N10-SEN Commission No. ;`� YPL'�,
YP"�i Notary Public' _N �_ tate o Flo S. NIELSEN
�p S "B,,,State Fior*da 207484 - Notar
Commission No. , GG '' Co ion G
on # ;9rF POP: mmission # y Public
+_ Com emission Expires °;�„°.�` my Comrnis n E207484
%n, p rn. Cor 2p22 uune 12 202xpires
June 12,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19