HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -�
Date: �-' "� Permit Number: ousJ
RECEIVED
e
' Building Permit Application APR 2 6 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:PROPOSED]MPROVEM ENT LOCATION:
Address: l I�/_
Property Tax ID#: A — 1 q W��`- �� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
E4 ()�d
FCONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all.that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows ors
_Electric _Plumbing _Sprinklers _Generator \Roof Pitch
Total Sq. Ft of Construction: r1 Sq. Ft. of First Floor: ll
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: -0'111e- Company: )_�
P Y�
City: �`'C �G-' State: Address:
Zip Code: 3 Fax: City: 4 rcP Stater
Phone No. Zip Code, Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail Yr
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 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 thepermit holder to build the subject.stfucture
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 AN ATTORNEY BEFORE RECO R NG,YOUR NOTICE OF COMMENCEMENT."
I
(�gn'Hire of Owner/L ssee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF•Sr4 L o .e COUNTY OF sA L%3 o e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of El'D'1Z'%\ .2014 by this' Co day of 2 20\R by
W%\\kan.-►�
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 Identification
Produced-:%L 7t�� Kerianne Berry,
Produced-AL 'ZM-i\ t4% L%M"tR
�6SN
� NOTARYPUBLIC Ry4& Kerianne Berry
SaQ y NOTARY PUBLIC
o :;2
—STATE OF FLORIDA RIDA
=STATE OF FLO
Comm#GG299064 .
(Signature of Nota Public-State I daaxpires 2/6/2023 Kignature of Nofdy Public-State dlPffraa)Expires 2/6/2023
Commission No..G (all Oct 400L/ (Seal) Commission NoGGCri 99.010'{ (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19