HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7`• �' �� Permit Numb r
R' E C I%.-I E D
APR 19 2059
Building Permit Appliction
Planning and Development Services 1"Permitting Department
Building and Code Regulation Division 5t. Lucie :ounty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSE1911 ROUEMENT LOCATLON:
Address: (o��� fQ/'r���'ie� 1"!'A • ` 5�"P ie-sce-
Property Tax lD 000 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE�-SCRI�PTION OF WORK:
CONSTRUCTION IINFORMATION:
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: $ \ 60 Utilities: —Sewer _Septic Building Height:
OWNER/LE�SSE jJt CONT NO%
Name �eu n D ; e Name. 9 ,ecrS
Address: V761 'S4- TO�A- Sh- L L1G,'� ompany: Ow e''S
City: L u C,-,O- State:,L Address: 3® F S&I 11 /tG i-.►q -N- L'
Zip Code: 3Y' Jlo2 Fax:° City: 14- State:A/
Phone No. ! Zip Code:3ylr" 6c Fax:
E-Mail: Phone No 3� l 7 5-�� 77.77
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 7 5E:� C (*l41
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.
it
SUPPLEMENTAL CONSTI2",N LIEN11LAW INFflRMA IO
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 orl.4--Wrding your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR}�A N STATE OF FLORIDA '
COUNTY OF /!/GG✓� ,/� COUNTY OFh 4
The forgoing instr meht was acknowledged before me The for oing ins tr ent as acknowledged before me
this AL day of 20 by thisday of 20 AO. by
Name&person making statement. Nam6Sf person making statement.
Personally Known OR Produced Identificationy Personally Known OR Produced Identification
Type of IdentifiS7zCion Type of Identifi on
Produced Producedell
(Si ature of N'bRarf Public-S ature of otary Public'Sr L i�rida ) ��
�optr JENNIFER DOMINGUEZ
Pia;' JENNIFER DOMINGUE + c Notar�1(Public-State of Flo id
Commission No. e� Co mission No. ° '_
_ + ary Public-State of Florida -9l 'o;: �S�Mmission # FF 95361
•� � � FOF FlO�••
Commission # FF 953 18 MY Comm. Expires Jun 16, 01
N•`
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REVIEWS FRONTNGp---' `PES NS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 9/26/18