HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: @ � Permit Number:
RECEIVED
APR 0 9 2019
--��-- -- Building Permit Applicatio
ST. Lucie County, 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
PERMIT TYPE: Al L. OApC ► ou:� U tik�- Fcrr UY-D
-FROPOSED'IMPROVE MENT LOCATION.:
Address: LjWr? S�\c;"W cvj t),A,
Property Tax ID#: ULA 11 "'n(2 5 a"oco ^ Lot No.
Site Plan Name: Block No.
Project Name:
-DETAILED DESCRIPTION OF.WORK.
DL
CONSTRUCTION INFORMATION: - -
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:$ r�)Lo-do Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name ^�� A .eo i r Name: `R
Address: 5 (QJ02 sy\ d f" L�A Company: t ` oI
City: Irk- ' %COQ'-yC.- (�-L(}L State:4rJ- q Address: 1-oc, CiLS32.o A-i✓.Q
Zip Code: Fax: City: R- 'PLe.'ra— State:
Phone No. Zip Code: 31,clx';�O- Fax:
E-Mail: Phone No F)"71ALDiI -S,)a/
Fill in fee simple Title Holder on next page(if different E-Mail ! i.Q-p0a(0- Q- 4a t-
from the Owner listed above) State or County License CAGIA:11 (WO
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 CONSTRUCTION.LIEN 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
P9STfP ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF U NTEND TO OBTAIN FINANCING, CONSULT
ITH Y UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N01rICE OF COMMENC MENT."
/I -
SignaLessee/Contractor as Agent for Owner Signature tractor/License Holder
STAT JrOF FLORIDA STAT F FLORIDA ,
COU TY OF `��- a—U��� COU OF Lx)est
The forgoing instrument was acknowledged before me The fgoing instrument was acknowledged before me
this day of 0\ p f 2011 by this K day of20 1�by
sa S� �OJS� 5a��dw. 5��c1o5�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica_U'on Type of Identifipn
Produced `§rL Produced l•
(Signature of Notary - fj�p 0PdIVENS
DEANNA MARIE (Signature of a @@rc-Sta
M� 15SION#GG 0220'l3 1 =?°' - MY C MMISSION#GG 022023
Commission No.6qd M� I.Demmber%2020 RCommission N - C3�A ES:Decerr"2AF020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19