HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application MAY 14 2019
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 APPLICATION FOR: To Select from dropbox, click arrow at the'end of line
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Property TaxlD#: I�Jd�- (a15 -(M"19- Com- g Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to aer orme under this permit-check a appy:
HVAC L1 Gas Tank Gas Piping Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers []Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 1 dU Utilities:]Sewer[]Septic Building Height:
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Name I� i L�Z� Name: S
Address:-gq(p3� �T12U�� S Company: C LA
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Address: Mvia, Lat&,l RA
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_ le(-C Q_ State.Code: J0 �
Phone No. Zip Code: 3'-1 D -- Fax:'
E-Mail: Phone No. 1121.- L\W-A (0 ZS
Fill in fee simple Title.Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Iq-Con 113g3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
pplicablerMsfftt o1O.ta37t+?,ER..SfQ�FTayY e
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,Gl'IE.V t COMPANY:
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oty'Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
j. City: City:
Zip: Phone: Zip: Phone:
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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.
Signatu Owner/Lessee/Contractor as Agent for Owner Sign to of Contrac or/Licens Holder
STATE OF FLORIDAff '� � STATE OF FLORIDA
COUNTY OF Lel COUNTY OF
The forg ing instrument was acknowledged,.,before me The forg Ing instrument was acknowledge before me
this day of 20_L-1 by this 9day of 20 by
Name of person ,iaMing statement Name of personaking statement
Personally Known ✓ OR Produced Identification Personally Known t/ OR Produced Identification
Type of Identification Type of Identification
Produced A Produced
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(Signature of Notary Public-State of Florida) (Signature of Notary Pu ' - t of Florida
\�t'ppY PV/� KA S. iVIELSEN
Commission No, KtEN S. NIEL T i sion No. ;� a�'; � 1
_ _State S. NIE Public
Florida-Notar Public =* *_ Commission # GG 207484
ission #GG 207484 %� ^�FofF�o° My Corn;nission Expiras
fission E ire, nmIWA 4 42, 2,922June 12, 2.0 2
REVIEWS FRONT VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
'RECEIVED
DATE
COMPLETED
Rev,8/2/17