HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5- p ) - Permit Number:
RECEIVED
COUNTY
MAY Z
Building Permit Application 2 1 O19
Planning and Development Services Permitting Department
St.Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT
Address: (90)9' iitJ Lettuce) 04 Let. P12)PN Fi ,
Property Tax ID if: YVAS- &OS"- 00YP- 000- 0 Lot No.
Site Plan Name: Block No.
Project Name:
DETAI LED DESCRIPTION OF WORK:
T4,
Fee M-C )(0)c 7 Cevar ..boo' I&,c F1Uvu ad*
pyray door.
,CONSTRUCTION INFdRMATICIN:', "o' —- • • "
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:$ 700 . 00 Utilities: Sewer Septic Building Height:
'OWNER/LESEE:'" .; • - 'CONTMCTOR: -2 --
Name StrepA to ifilerta-y Name: Jo ; Lope 2
Address: /636, hJ, EA/ Dr. Company: ej,0;te 6-the Act,
City: eViint PleCISOL4 BoirD State:N‘r Address: 181'7 Ali 11 1 1 dc r) Ave.
Zip Code: 01.7 ya Fax: — City: 4,4 51. 1A-tele State:
Phone No. (77. 33(0- lees Zip Code:Jy95-3 Fax:
E-Mail: Phone No(7 370 ti 'Co
Fill in fee simple Title Holder on next page(if different E-Mail j pot telly gi) topW)
from the Owner listed above) State or County License 28.4c5#3
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 LIEN LAW INFORMATION,,,, '` '`
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: —Not Applicable i
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N TICE OF COMMENCEMENT"
S' nature of Owner/Lessee/Contractor as Agen'wner Signa, e of Con factor/License �
STATE OF FLORIDA - STATE OF FLORIDA )•
COUNTY OF S H.11 CA,P__. COUNTY OF 0A-1—_R-QL-(
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_21.day of nY ,20_iq by this _` day of / - - ,20 qby
Name of person making state ent. Name of person making statemen .
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Z( --nI Produced f( — -L--
l/
(Signature of Notary Publi tate of Florida) (Signature of Notary Public-Safe of Florida) '
"�"" S13�1�N VAUGHN ��"V t'� E(LS��IN VAUGHN
Commission No. ,;;PRY Po:%, .mmission No. rR ��,
Iii :State of Florida-Notary Publ c ? 111:7:: ��Stateof Florida-NotaryPubli;Commission # GG 270079 � °`" Commission #GG. iii ,ec 97nm% of o`' P'IY {figfl ion xp re31o``� y ommission Expires
REVIEWS FRO -�. . ; ---t= _ LANS VEGETATI ` ._.:,,. to :,r � c i d'. E
COUNTER REVIEW 'REVIEW< REVIEW REVIEW REVIEW liEvInvill
DATE i
RECEIVED
DATE
COMPLETED
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