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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ' , "4 Permit Number: Q O RECEIVED Building Permit Application APR 18 2019 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 PERMITTYPE: PROPOSI?D INP QVEMENT C?CATIO Address: Io��3 Sou .�nall�a•-, �1�ey,o�!`• e�'x5C'1� IQc Property Tax ID#: 0 ' 620 Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WOR+K: QLi a CONSTRUCTION I FORMATI(ON Additional work to be performed under this permit-check all that apply: / _Mechanical _Gas Tank' ; _Gas Piping _Shutters V 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: ©WINS!E-RE LE-�SSEE. CONTRp►CTCtR: Name SO& Name: hV S c- 4.2 Address: /rZ t7 3 .717 o�✓-_ Company: ,;1� sen �lho�P�e/t 15��• oh 1+�q City: 4GC k-. . Sta .5 te: I Address: S 'SW74Xbr-0X err' Zip Code: 3y9S Fax:'' City: ��t '�S� I-.���`e State: 4C1 Phone No. 772% 323 6.76:tl Zip Code: 3Y993 Fax: E-Mail: Phone Nor 772 -Garp= X030 I Fill in fee simple Title Holder on next page(if different E-Mail cfen n S(3 40 e CO 1-1 from the Owner listed above) State or County License C*C 15-2101 Z 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. SUPPPENT,OUR AC WNS' R,4UCTION LII�N LAW I'A WRMATI�N: 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 appllcabl&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 inspectiogIf you intend to obtain financing, consu t with len r or n attorney before commencing work or recd,rding your Notice of Commencement. Signature of Owner/Lessee ontractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF C, The forgoing instru ent was acknowledged before me The fo oing instru lent was acknowledge efore me this day of 20(� by this day of 20 by 'S h F.F.W M 15 SAN NF,E- Name of person making statement. / Name of person making statement. / Personally Known OR Produced Identification V Personally Known OR Produced Identification ✓ Type of Identification Type of Identiftatien Produced {'L Produced AA S (Signature of Notary Pub io-S at o Flor'da (Signature of Notary'Publio-State of Florida) b P��i KA ILEI S. NIELSEN l -S. NIELSEN Commission No. B<<_State 5RPl�rida-Notary Public Commission No. �AyP��, Kd o 'Commission# GG 207484 * -State of Florida-Notary Public , My Commission Expires :� _ Commission #GG 21 u ?, „o'iF�oP:` y o mission Expires REVIEWS FRONT ZONING SUPERV OR PLANS VEGETATIO �u a COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVI DATE RECEIVED DATE COMPLETED Rev.9/26/18