HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S7. / • Permit N er:._- .--0 / 0 .
LPePmitting
l �
� _ �.�Y 1 2019
Building Permit ApPlanning and Development Services Department
Building and Code Regulation Division ie County I
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: -
c � .
PROP'O:SED IN'PFtO r•�MENT i3CATIC}N;
Address:
Property Tax ID#: �� �' (�9 S r(J o / � Lot No. Z
Site Plan Name: T, 104 CP_ Block No. '_2� l
Project Name: �iWL F—CK c"e-_
D TA I.E[3 DESCRIPTION OF ORIC:
60Orn1 0&7
����e9.. �✓D4� py "v�c�
CQISI RUCTION INFORMNI'tN:
Additional work to be performed under this permit-check•all that apply:
"M'ha ical Gas Tank - Gas Pip in g Shutters Windows/Doors
s', ..: , _.�
.Electr►c _Plumbing _Sprinklers j„ .1 Generator° _.Roof - Pitch.
Totalq. Ft,of Construction: Z90 :"!Sq..Ft..'of first Floor:
"
Cost�f:Gogstruction: $ Utilitie's: ;_:Sever Septic Building Height: f�
CiWN �R/LESSEE• •• NT CTQR:
Name G e CA! !� r' � Name: !✓&rna�ro� ��rrrc�•� �4/���`0vv� Ll-C-
a
Address: 6 5tc_9t-apL ®j Company:
City: )-IJ t-7L I 1 y V cy State: FL Address:
Zip Code: C06 Z Fax: City: Vrrn 13Ro c A State: -PL
Phone No. 7 7 Z -cl 6 _ Z 52 Zip Code: �Z 9G Z Fax:
E-Mail: Nth Phone No -:57) ��q S� 4
Fill in fee simple Title Holder on next page(if different E-Mailc��r,.-c0 .,C,`�ta
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.
Sl�'P.PLEMENT L CONST�RtIJCTI®N LI,�N LAU1( 1NFQ �+MA IQ,, :
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 Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent fo Signature of Contractor/License Holder
0
STATE OF FLOP4DA1 STATE OF FLORIDA
COUNTY OF =figA COUNTY OF ,a
The forgoing instrument was acknowledged before r The forgoing instrument was acknowledged efor
this day of 1 20W byc o co this day of 20 lby
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identificatio Personally Known OR Produced Identifica
Type of Identifica ionpp ype of Identific n
Produced "b c_ `� roduced )IA .
(Signature of Mtary Public-State of Florida U (Signature of Wtary Public-State of Florid )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
1:6e__V.