HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
Date: CA �' �. Permit Number:RECC XERVED
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JUN 1 8 2019
Building Permit Applic omitting Department
Planning and Development Services
Building and Code Regulation Division 5t-.-_.LU.CLe COU nt�/, FL
2300 Virginia Avenue, Fort Pierce FL 34982 •
Phone: (772)462-1553 Fax: (772)462-1578 Commercia !Residential
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PERMIT TYPE: �I C e, r 1 L'A_0_ �_.___....
L"PRC}FQSIAD IMPgROVI*M�N d LOCATIQN �, 3 a 3' `
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Address: ��� /✓»61il� l.!/�'
Property Tax ID#: 2'g �5 Lot No.
Site Plan Name: Block No.
Project Name:
7777777777771
DETAILED DESCRIPTION O�WORK �� d x YE,
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CONSTRUCTION INFORMATION
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
V/Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ lley`° Utilities: —Sewer —Septic Building Height:
�0►WNER/LE55E �� , �P� � �� � � ' ' }��.��ONTRRC���R���,�U�����-�� � �� 3� �;N �� ��� �
Name e A'0- Z/19 L Z,9 4,1 .-d Name.
Address: Company:
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City: YG�G' �c�: '�2cc.E State:_ Address: /�..�7 �2ti � U72iyf'6 S
Zip Code: �49��z�/1 Fax: �1 City:/. � �zWX Stater i
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Phone No.ss? Zip Code: Fax: /i? .
E-Mail: Phone No 9:71/x9--y �Z j
Fill in fee simple Title Holder on next page( if different E-Mail kpi� .2 row 9fi�'1
from the Owner listed above) State or County Licensee GO/3�p
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.
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SUPPLEiVIEI `f LONSTICTt(7N ,iN 1AtN�IOR ee�ggAT £ C� ,
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
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 NOTICE OF COMMENCEMENT"
Signature of Owner/Lessee Contractor as Agent for Owner Signatur of Contractor/License Holder '•"•" ''
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STATE OF FLORID_ ' �' STATE OF FLORIDA no c
COUNTY OF COUNTY OF J �2°��°' i R
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The for ing ins ent was ackwledged before me The fof ing instr ent was acknowledged b rFr =
this day o 20by this /0 day o 20�
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V jo IV 5��e✓ N w
Name of person making statement. Name of person making statement. V �
Personally Kin wn OR Produced Identification Personally Known OR Produced Identi ication
Type of Identificat n n Type of Ide i ti n
Produced c 1�• �C Produced
(Signature of N t - (Signature of No Public-State of Florida)
, YP AUDREYB.HUMPHREY
Commission N MISSION( Gl$00817 Commission No. (Seal)
'or EXPIRES:March 6,2023
'''•�§orF�°:' &nded ruWaryPublic Underwriters_. J
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2 9