HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �0 �7„ Permit Nu t ,
RECEIVED
•
_ Building Permit App kation
JUN 13 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Ont FL
2300 Virginia Avenue,Fort Pierce FL 34982 y i
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
.'PROPOSED`'INPROVEMENTL�CATION' �" ,, '
Address: IAC-= Gi C-L 3%-A9 3Z
PropertyTax ID#: �� �r � y - - ® � Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED.DESCRIPTION OF,WORK „ .
0A441—V45i-'--7V'— � 4- ,ICE �D �Gc �siDutr
;CONSTRUCTION;INFORMATION.
Additional work to be performed under this permit-check all that apply:
Xmechanical _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:$ 00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 146ll/ /3 Name: y Ue:!�3eq �'�rcuJt�2 c/o 14d
Address:-V-0 Company: 604V-4 (e r- /a k-
City: ��S L State: ;4';(- Address: 3 &) Az((oc RJ-
Zip Code: 3'42 s-a Fax: City: S • State: +�.
Phone No. a , -22 0J.3 . Zi Code: 3,` �� Fax:
c'a g 9 p 1�1
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail Q VzWAA,11 o Ht►6Foy . ��.
from the Owner listed above) State or County License eA I?
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 LAIN ( IOWA ,,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 thepermit 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 recordi our Notice of Commencement.
Signature of Owner/Cesseertblror as Agent for Owner Signature of Conti-ado r/
on or/ older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �4 (l9C.Q`C- COUNTY OF
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this da of���.411e 20 f� by this 1� day of �.�V10� 209 by
F 41W&I-mg �a 7C'o
Name of person making statement N me of berson making statement
Personally Known OR Produced Identification Personally Know OR Produced Identification
Type of Identification Type of Identific tion
Produced Produced
(Signature of t lic-State of Florida) (Signature of Notary -State of Florida)
Commission No. RESNILLO Commission No. JO E NILLO
4PA P�'9'moi
_r o:StaEoforida-Notary Public tea° ��-State of Florida-Notary Public
Cion # GG 2727.47 _ Commission # GG 272747
KA
xpiras
1991,11
of 22 2022 bacembar 2 2022
REVIEWS FR PLANS VEG
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17