HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: Permit Number:
RECEIVED
} Building Permit Application
MAY 3 12019
Planning and Development Services
Building and Code Regulation Division ST, Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4.62-1553 Fax: (772)462-1578 Commercial Residential V.�
PERMIT TYPE: a {
PROPOSED IMPROVEMENT LOCATION:
Address: g`ly
Property Tax ID#: ., *5 ` 7171' Lot No._—_
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: /
a n cZ d, O 6,k o a-
CONSTRUCTION INFORMATION;
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:
�i+G7
Cost of Construction:$ /, �)OD Utilities: —Sewer —Septic Building Height:
OWNERAESSEE :CONTRACTOR:
Name rid e ,rr , i�r,u ¢ Name: �� f16e
Address: Company: - 9 6a 4.
City: Por 4- SA. State: P L Address: 7'Lt / s � ceJn-8)'J
Zip Code: 5k4'f -Z Fax: City: z.,cr-r— Stater
Phone No. Zip Code: tS- Fax:
E-Mail: Phone No 7 Z2 �W Z 5-36,k
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License ?20 3`7 C9
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
Name:- Name:
Address: Address:
City: State: City: i State:
Zip: Phone % Zip: Phone: /
FEE SIMPLE TITLE HOLDER• _Not Applicable BONDING COMP 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 B SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH_YOUR LE DER O N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
SianaJUEt2LPn ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �� . 1.uc \'�, COUNTY OF Sk
The forgoing instrument was acknowledges{before me The forgoing instrument was acknowledged before me
this3�day of WN20_ by this 31 day of w,a�Al 203by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced `F �- ►D
(Signature of Notary Pu ic-State of Florida) ignature of Notary blic-State of Florida W
NNAP.4ARIE GryENS -.. --`— -•--�`p
Commission No. dam. •ye„ / �L" NAPJfARIE `EN r
=or'
�s (My� MIJ115510Ni#GG�20� C mISSIOn flISSIONt#6G 23
�. , * EXPIRES:December 1G, lets a . :
;d3 0 Public Underwr a, GCPIRES:December 16,%02J
REVIEWS FRONT SUPERVISOR PLANS V `f n A TURTLE i MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.Z/7/19