HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� i
Date: 5— / s"�1 Permit Number: 1�'"1�' 0 \ 1/5
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_ Building Permit Applicatiopr�t��9oP�?019
Planning and Development Services ��e Co are„,
Building and Code Regulation Division `qty enh
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMC 'LOCATIONo
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Address: / 0' 5tl (3Ce4 n ef' U L/ -7 J
Property Tax ID#: 4/$JJ SO a. - 00-3'1 - 00 t- i Lot No. Il
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Site Plan Name: Block No.
Project Name:
DDIEFAILED DE C.RIPTION CiP WORK?
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fart I', ha 41 A/ .r! 77 ik,,Le!...4 N .e s4/n_ilVi le_
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CONSTRUCTION IN''FORMA I®N . • ...
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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 L///Z "Pitch
Total Sq. Ft of Construction: 00 s4 Sq. Ft. of First Floor:
Cost of Construction: $ / 00 b Utilities: —Sewer —Septic Building Height:
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CW ER/LE:-SH ': • •.: ,° =$ 'CONTRAC«f®RT
Name Marie ,g_ A : I A I !r, l n d
Address:3/Lig ' !! EE Company: 4_. i ,1 r
City: . '1D,- i y) State: FL Address:
Zip Code: ,3} D, 0 I Fax: City: • State:
Phone No. i?3 -. j. I y --yl, 7 Zip Code: Fax:
E-Mail: bi vby, i mt� i � 1 U Pi I Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
1
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.
SUPP IEMENTM.@CYNSTROMTION LfIgN LAW )NPCNRIATIGN:
DESIGNER/ENGINEER: lin Not Applicable MORTGAGE COMPANY: Al Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Pi/ Not Applicable BONDING COMPANY: N/ 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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."
Signature of Owner/Lessee/Contractor as k gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY COUNTY OF
OFC�---
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me this day of , 20 by
this ç _day of 1 y , 211 by
CI -Le
r) V j �.erv�,(�v Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification Type of Identification Produced
Type of Identification�I"
Produced L_ 0 C
(Signature of Notary Public-State of Florida )
(Signature of Notaryl*Nift.imtatiadailalsw.isJA.l Commission No. (Seal)
$41114, ELLEN VAUGHN
Commission No.
4$41114f_,, ELLEN
of FCs5d }Notary Public
Commission # 06 270079
'.9t3cTicp My Commission Expires
Octobor�2, 2022,.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19