HomeMy WebLinkAboutBuilding Permit Application All APPLICABLk INFJ0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED�
Date: OWNZO)CPermit Number: S�,C��L(1.
RECEIVED
i '
• APR 10 2019
Building Permit Applicati n
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34952
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: P? CAL
P:ROP.,OSED IMiPROVEMENT LOCATION:
Address: all1F-M LU(ZPA &ORT R, B1OZ�F_ -349
PropertyTax ID#: "I`�"��""�01 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED,DESCRIPTION.OF,WORK F°
. r
ELEanCAL WIRING F-Ciz New WE oji- mr , iR COKOITIOPEK
&YYT �f 6PPrn8,k11N*)
CONSTRUCTION.INFORMATION r
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Additional work to be performed under this permit–check all that apply:
clylechanical _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/LESSEE N CONTRACTOR
,
Name 1z- TFTyi-FA Name: jigpm H MgMSIA6
Address: 116 (eta Ex-F-Nla Cir Company: cl6HE- F- I!
City: rT. tugs State:Kt Address: OKEPWO
Zip Code: 7-V Fax: City: V II�E State:
Phone No. `Ti���� Zip Code: 51 Fax:
E-Mail: Phone No (77Z) 5�ff-Z`1
Fill in fee simple Title Holder on next page(if different E-Mail 5W51* 1995 4Mz,,C.09
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.
SUPPLEMENTAL CONSTRUCTfON LIEN LAW INFORMATION
' 'r �.`� �•.•
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 thepermit 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 ANATTJDRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
A),
Signature of r/L see/Contractor as Agent for Owner Signature of Co t or icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .�(! COUNTY OF . • l ��,t�
The fo oing instr ent was acknowledge before me The forgoing instru��entwas cknowledge efore me
thisI� day of �1(� 20 by thisldayof 20_Yby
Name of pla maging statement. Name of son Making statement.
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Iden tif ,on,,, Type of Identifica� y�
Produced ,,_ Produced_ !—( _ l.JL
(Signat ure of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Commission No ,u�u,7State
EN S.(�WQLSEN Commission No. p� h _
=o` Florida Notary G 2074R84
Public ra-4
� 8,,, ARE��. NIELSEN
ission #GG 2074II4 ;State of Florida-Notary Public
*= Commission # G
oFf`o`�. orn F I
�2, 20 2 ",'14 oP°,� My Commission Expires
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