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HomeMy WebLinkAboutBuilding Permit ApplicationDate: v -X i INFO , MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f� j L e I 1 "IJPermit Number: `' ©1� Building Permit Application 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 PERMIT TYPE: Property Tax: ID #: Site Plan Name: _ Project Name: _ RECEIVED JUL' 01' 1019 Permitting Department St. Lucie County Residential_ Block No. 'CONSTRUCTION IN'F0RMA310N 1 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 4. Z Pitch Total Sq. Ft of Construction: 2'� Sq. Ft. of First Floor: Cost of Construction: $ L2) o uu Utilities: —Sewer _Septic Building Height: OWNER/ LESSEE: ON TOR Name Name: G Address: AW Company: City: State: Zip Code: 2 Fax:. Phone No. ��(��� `-)" o E-Mail: Address: City: �- Stater Zip Code: li� J�11 Fax: Phone No Fill in fee simple Title Holder; on next page ( if different from the owner listed above) E-Mailktbfi ( . cow State or County License If value of construction is S2500 or more. a RECORDED Notice of Commencement is reauired. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. H K R60FI KC-p 7-06?MW I C-6m S.FIPPLEMENTAL CQIVSTRl1CTION I;IEN 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 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 LENUR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." 1.0 . rag"I�e� Signatur of Owner/ ssee/Contractor as Agent for Owner Signatur f ontrac r/License Holder STATE OF FLORIDA ` STATE OF FLORIDA - t� COUNTY OF(kl-Q MY) I1 �Le* COUNTY OF d l (IM R1Ucr The forgoing instru ent was acknowledged before me The i'-' instru ent was acknowledged before me thisay of "Pi 2011by thi day of 20� by Name of person making statement. Name of person making statement. Persona Ily.Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced 0 MAO (' nature of Notary Publi �wr °kry Notary Public State of Florida nallure of Notary Public- S a Notary Public State of Florida M�lc Commission No. L1%rnlse Ball Mfg oSNmission GG 036768 ommission No. �enise Ball G 036768 oRno~ Expires 10/08/2020 , 0 lo,0o�S� E7!! REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLEOVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW W DATE RECEIVED DATE COMPLETED �_ev.2/7/19