HomeMy WebLinkAboutBuilding Permit Application All APPLICABV INF9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1( Permit Number: lJ
RECEIVED
• °I PR 3 ® 2019
_- Building Permit Applicati Dn
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 ✓
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:,
Address: L14(-9 re SSLer
Property Tax ID#: 7? Oa - C`�O 11 -L7 w r Lot No. 1 a� 1�l
Site Plan Name: Block No._ 3
Project Name:
DETAILED DEkRIPTION'OF WORK:
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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:$ Utilities: —Sewer _Septic Building Height:
b1NNER/LESSEE: :a CONTRACTOR:.
Name Name: .
Address: l �_Q re SS_le-,r- L^ . Company:
City: -rte Q;eec a State: Address: Pre n(.v Li,-
Zip Code: `x-49 Fax: City: State:
_F�z
Phone No. Zip Code:_2u5 )- Fax: AAA
E-Mail: 42 vr^e;n c /) (2a-'(-C--4- ,e%-ct Phone No ")'!'J- /6- < 5�
Fill in fee simple Title Holder on next page(if different E-Mail c 6r)
from.the Owner listed above) State or County License N �r4
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.
S-UPPLEMENTAL 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 TITLEHOLDER: _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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Sig re er/Lessee/Contractor as Agent for Owner ;ATE
at C t for/License Holder
STATE OF FLORID��.►,, OF FLORIDA
COUNTYOF I_Anct,� COUNTYOF S+ loci e
The forgoing instrume t was acknowledged before me The forgoing instrum nt was acknowledged before me
this ailay`of n' 20 a by this`9_rdayof -i 20J by f i
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identi Personally Known ✓ OR Produced Identifica on
Ty of Identification ;+�;Hoj: a of Identification O'-
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ro uced
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ature of Notary ublic State o ort iffa) 9 j 3 n (Si ature of Notary Public State of Florida)
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REVIEWS FRONT ZONING UIQI PLANS VEGETATION SEA TURTLE1_,RdE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.Z/11/19