HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:, Permit Number: 07, QQ?(o
U
® M� RECEIVED
Building Permit Applic tion JUL 3 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. L<u ie County, FL
Phone: (772)462-1553, Fax: (772)462-1578 Commercial
PERMITTYPE:
Address: A1_. AIVOWL11& /V:%X A'T 6/,0 Aa_n7- PICW- ekFe
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED-DESCRIPTION
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CONSTRUCTION'�,�INFORMATION U `.`J:Ial-
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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: (3 Sz. F'r. Sq. Ft. of First Floor: /5`0 2'
Cost of Constraction:$
Utilities: Sewer Septic Building Height:
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CONTRACTOR
t) Name:
Address:
Company: 13,4 -Afc-,05�
City: rwtT Rrlwa, State:F4- !Address: S3/ Za 7N/ 57-
Zip Code: Fax: city: ",e- 0 a, State: -,'–Z-
Phone No. 77ol-3Rl- )3g9te Zip Code: 3a q Fax:
E-Mail: 01,11rLeqot)2 10 Phone No
Fill in fee simple Title Holder on next page if different �E_Mail Cory?.
from the Owner listed above) !State or County License C_ r,
If value of construction is$2500 or more,a RECORDED Notic6of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice'-of Commencement is required.
SUPPLEMENTAL CONSTR;UCTION LIEN. LAW INFORMATION .{ -
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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: AZ, 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 SRE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
r" Signature of Owner/Lessee/Con tr ctor as Agent for Owner "Signature of Contractor/License Ho er
STA*YE-OF`FLORIDA - -___._. STATE OF FLORID
COUNTY OF S-r, Lucie , COUNTY OF
The forgoing instrument was acknowledged before me The fo oing instr nt was acknowledg-d before me
this 2�day of TU CtIQ ,204 by this day of 20 9.by
Name of person making statement. Name of person making statement.
( Personally Known_ OR Produced Identification Personally n OR Produced Identification
Type of Identification Type of Ide ifii: 'cin
f� Produced Produced ( �.
I
a�
(Signature of Notary Public- tate of Florida) (Signature of Nojarq Public-5C,te of FI rida)
Commission o. ►_ Swte_or� a : - Commissi ��o'� AuoREYe-HUMPHRE eal
Lester B Goldman '"= MY COMMISSION#GG 300817
My commission GG 24417
as 2 r'ocper
REVIEWS PERVISOR PLANS Bonded Thr NotaryPubrcUnderxri yi ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
eV_
2/7/19