HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �i ^� �— /� Permit Number: � g
Building Permit Applica ion f
Planning and Development Services JUN Z 4 2019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Perm�ttlR _
Phone: (772)462-1553 Fax: (772)462-1578 . COfT mefiCial R� id Q tli l pa rtmen
PERMITTYPE:
PFS� POSED I�M'PROUEMENT LOCATION:
Address: OC._
Property Tax ID#: 5 _2 — 0 Lot No.
Site Plan Name: Block No.
Project Name:
QETAILED —N
DE�SCRIPTfON OF WORK:
r' H eat 6—
+ •INSTRUCTION I!Ni=O1ION:
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:$- ice Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 4�-P., leo
L Name: r Z GU
Address: 1&�:12-ka 6-(Company: Z. .
City: '�"` ` - State:_ Address , ,, G
Zip Code:• Fax.r City: T ;° State
PhoneNo / ). 4" Zip Code Fax:
E-Mail: Phone No `5 D 3
Fill in fee simple Title Holder on next page(if different E-Mail cl Z cv v �UU e,
from the Owner listed above) State or County License
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 C•UNSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
;City:: 3' State: City: State:
Zip Phon-e; 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 IF NANCING, CONSULT
WITH YOUR LENDER ORA ATTORNEY BEFORE RECORDING YOUR TICE 17COM N
Signature of wner/ esse&, tracr as Agent for Owner Signature of Contractor/Lic nse Vorder
STATE OF FLO - STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instr e was ack owledg d before me The forgoing ins ume t as acl nowledge efore me
this day of 20 by this_LK day of 20by
'N'ame of person makin/g sta ment. Name of perso aking statement.
Personally Known C OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Lf/
(Signature of Not - FI rids ( ignature o No ry Public-State of Florida)
;iot"•"•�':'°i;� AUDREYrr�� H'�{MPHREY
Commission No. COMMISS1�Kfl,GG 300817 I Commission No. ; � AUOREYB•F�IPREY
I .,: MY COMMISSION#GG 300817
EXPIRES:March 6,2023 r 2023
n enm ors nded Thru No Public nderumters
--- �FodF oa,• a �Y
REVIEWS FRONT ZONING SUPER R PLANS VEG VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19