HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO) MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' / �• Permit Number: lq D-7 a�7 1
RECEIVE®
. Building Permit Application
JUL 2 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 t C I 0 U n ty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMITTYPE: N
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02_ _ .� 4.. .. :
Address: ID9 -EASV St
Property Tax ID#: Z-WY7 W76-DOO-`I Lot No.3of31�M
Site Plan Name: Block No.
Project Name: 140A" Itii[�+ii?S
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters -gWindows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ '2.000�� Utilities: —Sewer _Septic Building Height:
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90
Name iloe+•k i.1 s u-_ Name:�i�t�e+1e,-S \'1oAr.J1
Address:2A6 �F )4'j11 4,1166 t&2Ab mr_ Company:
City: MiAr•.1.j State: FF_ Address: SD l 14W
Zip Code: •33(10 Fax: City: � icLZeP-e-Lt State:
Phone No. 1772 528'1V88 Zip Code: 34-15'1 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail G �i SoUI 2
from the Owner listed above) State or County License 12
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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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 Lesse0/Contractor as Agent for Owner Signature of Contractor icense Holder
STATE OF FLORIDA - STATE OF FLORIDA
I 1.. 191--.
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COUNTY OF � e-1 � COUNTY OF Si• kUC(P
The forgging instrurRent was acknowledgedefore me The forgging instrumen was acknowledged before me
this day of U,,� 20by thisI&Aday of Ll 20_a by
Name of person making statement. Name of person making statement.
ersonaliv Known OR Produced Identification P all Kno OR Produced Identification
Type of Identification Type of Identification
Produced Produced
-A-A AA VATwv"v�•., KATHRYN KINNE
(Signature f Notary Pub c �` f Fjl�[��&�blic-State of Florida (Signature o Notary:Pubric-f i t ryPublic-staceo Fcrira
lommission=GG'96'63
a o Commission=GG 196163of moMy Comm.Expires Jul 9,2022
( I moo? My�f§�1j ExpiresJu19,2022 Commission No. '"'g` ndedth7oug�i'�ationatNotaryAssn. Commission No. "•i�ondecl[SMQiNationalNotaryAssn
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