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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �JIaa1 Permit Number: \4V0S'0 S3
-
COUNTY
iI
Building Permit Applicat on RECEIVED
Planning and Development Services MAY 2 2 7019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie Ceant}^ -Ormltting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residenfiiai�-
PERMIT TYPE: G
Address: 5A IX MAIL4- (�W EN ..pff-W&I..x W1 pl4_6 N
Property Tax ID#: 3©� �Q[,2j ' 03s�? '0190 Lot No.
Site Plan Name: Block No.
Project Name:
Wl104::. MINI'! �.w�a
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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 Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1600 Utilities: _Sewer _Septic Building Height:
a Qs
Name_A1Q t R-f (4poN Name: J 0,40A) k4L;
Address: [W CLENbI-LC Company: "1)9"W AWD 1046 .®-F-W- "T
City: Dina~kVVV State: NC, Address:
�,937 S. I:I�6S q 4)qZip Code: X"17 D t Fax: City: r i l p/ewe,_ State: '
Phone No. (�` Q( � ���-�. Zip Code: 3L&q Fax:22�'�Sa y
E-Mail: Phone No '7 7a— f yoq— %0'
Fill in fee simple Title Holder on next page(if different E-Mail d-earn 9 d ppl5'ard Wee-I"e,., eym
from the Owner listed above) State or County License C&C [33I�rqQ
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORT 4AGE C D Not Applicable .
Name: Name:
Address: Addres 2019
City: State: City: State:
Zip: Phone Zip: e. .—Parmitil.,
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize theermit holder to build the�subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or andcovenantsthat may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
"DARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING$ CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
��OJA� fil'� �_a W l w�
Signature of wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,c� day of 204 by this-?P*day of 20J' by
Name of person making statement. Name of person making statement.
Personally Known_�OR Produced Identification Personally Known AOR Produced Identification.
Type of Identification Type of Identification
Produced Produced
CAP
(Signature of NotaYy Public- tilt • '•FIopNDE ( "gnature o Notary Pu "
Commisslon O GG 198661 BETTY P f
Commission No. _ • oP� WIy2,2W C mmission No. 19888
'••.���4°� BaidrOThuTroyFttnGwrmcaB0039'�919 Emm�� �
1pfId101iWTayF�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
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