HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' �' Permit NumLation otm
�f�s' I
R.
AY 3 2019
..- ... �� � � � Building Permit AppliPlanning and DevelopmentServices ng U"partment
Building and Code Regulation Division ci@ CountYo FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
P';ROP@SEO" IVIPi27V�EiEl1Th GCA ICU
Address: 1.
C
Property Tax ID#: ( (� cJD ` n(]a�3-000– 4 Lot No.
Site Plan Name: Block No.
Project Name:
._ _
C0iSi5�1^#\ k/
Additi•nal work to be performed under this permit–check all that apply:
YMechanical _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:
rs
y-'s, :
Name: 'Dza-e-
Address: i�U3f� Y1CI�10 { Company: ot(Cc(m - Yo-an
City: �:-;'I-LI tkf+ State: FL Address: C i (1') i Y)S f-)q e_
Zip Code: u��J Fax: City: State:
Phone No. 7'7 2, L(�U ` C�8 G K Zip Code: q S l Fax:
E-Mail: Phone No -7 Z –Cj(�n 6g6 q
Fill in fee simple Title Holder on next page(if different E-Mail (c a k'l-0 Y%rv" ML-1
from the Owner listed above) State or Lounty 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.
41
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 M EMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. FIVU INTEND TO OBTAIN FINANCING, CONSULT
WITH-YOUR LENDER OR AN ATTORNEY BEFORE RECORDIN OUR OTICE O COM ENCEMENT."
Sig atu e?Owner/Less ontra r a e for Owner C G rf'se Holder
STATE OF FLORIDA ORIDA
COUNTY OF
COUNTY OF ���
The forgoing instrument was acknowledged before me The forgoing instrurrue t s acknow wedged before me
this &,O-day of 6� (t 20 1q by this'_j' day of �A v,201k by
�<n L�GtVVO;GU its
Name of person making statement. N e of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of 1 entification
Pr ce �� ro
;��pv'6e:, STEVEN LEVY
r°• �� Notary Public-State of Florida otiAv Poet STEVEN LEVY
Commission p GG 255569 Notary Public-State of Florida
• 2022 0 Commission#GG 255569
at re o is ate"CSf�dq� dough National Notary As na u f o P li'° o�l}����afipires Sep ,2022
ed{hroug N tional Notary Assn.
Commi sio o. (Seal) Comm ssio No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE /
COMPLETED
Rev.