HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ RECEIVED
r
JUN 2 0 2019
Building Permit Applicatio
ST. Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMITTYPE:
PROPOSED 1MPR01/EMfNT LOCATION•
Address. 7 9 (3,_V'C,
Property Tax ID#: 141% 762- It 1 -] - 000 " Z. Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DES HPTION W.WORK:
CONSTRUCTION INFORM Tlt)N:
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: ) ('00-00 Sq. Ft. of First Floor:
Cost of Construction:$ 09400 , o e Utilities: —Sewer —Septic Building Height:
OWNER/IUSSiEE: CONTRAC R:
Name on d S-e-" Name: Z
}
Address: sari..:.°.. � Compan C -_ C>.L/\Gf T -- us L
City: �l . �! 1 cif,' L .J � S I State: Address'.-'
Zip Code: , S ( Fax:' City: p f Stater
Phone-:No.- �'dnlf' - Zip Code:; _V6 S? Fax
s
E-Mail: Phone No y��"2 `Zi ; = 7 IOY
Fill in fee simple Title'Holder on next page(if different E-Mail S'fC o (7 pAc"�a 0.0( . G
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.
SUPP'LEMENTAIBM&NSTRUCTION ILIEN LAW INFORMATION:
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LE E N ATTORNEY BEFORE RECORDING YOUR NOTICE O COM CEMENT."
Signature orfner/Lessee/Contractor as Agent for Owner Signature of ntra r/License Holder
STATE O ORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Theoing inst ment was acknowledge before me The fo oing instr ent was acknowledge before me
this day of 20by this rday of 20 by
Nwo--, (-'-'?,&- - I V_r, ,' znu�
Name of person making statement. Name of person making statement. /
Personally Known OR Produced Identification Personally Known OR Produced Identificationy
Type of Identification Type of Identif' n
Produced Produced
I `
(Signature o - (Signature of No KAREN S. NIELSEN
��`"rv'',� KAREN S. NIELSEN - .�``YPi;'�
Commission cox°`� L° =State of Florida-N(o�f'aajl Public Commission No. �o`"� a� ,State of Florid @ry Public
_* *r Commission #GG 207484 =. vc ommission`# 207484
My Commission Expires
MY Commission Expires
' une , 20 2 "'��"
REVIEWS O VISOR PLANS VEG EA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/1/19