HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 1 Permit Number: ` Nd S 13 9,a,
•
RE EIVED
Buildirig Permit App-licati n ."MAY 01 2019
Planning and'Development Services
Building and Code.Regulation DivisionTL4lGfe County, Pe;rrnitting
2300 Virginia.Avenue,Fort Pierce FL 34982
Phone:(772).462-1553. Fax: (772).4.62-1578 COITlnlefCial .. Residential-
PERMIT TYPE: I.
PROPOSED IMPPROVEMENT LOCATION.
Address--.i,;. ��➢ G wA .Laa�.e: .
Property Tax ID#: 01 _5 1 �, ~.6 IS i` 0d � a Lot No.
Site Plan Name: Block No.
Project Name: _ i
:QETAIL,ED DESCRIPTION,OF WORK 0 :;;Q:,.1
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:$ 'fit®0.00 ,'Utilities: _Sewer _Septic Building Height:
E:;., ;,:CONTRACTOR:.,.
OWNER LESSE
Name U C. Name: 1rt 1
Address: i0 122 Company:
City: , L-or State: - Address: 35r64 tZ 4,1,,
Zip Code: 3`�c( Fax: City: State:
Phone No.- y(A , all Zip Code: 3-s'l if-f Fax: bs--eld
E-Mail:.,., Phone,No (pC
Fill in fee simple Title Holder on,next'pagg(if different E-Mail (�,. �N 4 A G'�
from the Owner listed above) State or County License (7G U1153-7
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 UE'N LAW INFORMAT.ION,:
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.
1 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 whichmay 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."
Signature of Owner/Lessee/Contractor as Agent for Owner_ Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF-FLORIDa�'
COUNTY OF 4k. L%3- COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this A_day of M o,N .204 by. this. day of W\g�A :.: 201 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ProducedI Air nni;N0,
rft 1:
(Signature of Notaryu c_, t pf FI I - b D22023 c
�j f gISSION# �(Signature of Nota 3�i(i"c`.�tat�q f; idar)N
� :
' EXPIRES:.Derember 16,2020 * EXPIRES:December 1,8,:?07.a � .
Commission No. d� a Boy EtE1 NotaryPulll�UndarVtiters y�ommission No. �� A ondedThruNot�SRy� I�Uiidc riiers�1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION.. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW , . REVIEW, REVIEW. REVIEW,
DATE
RECEIVED
DATE
COMPLETED
Rev.