HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF BUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: 1• Permit Numb r
RECEITAT'N'
eU-A
• n JUL 8 2019
Building Permit Appli tion
Planning and Development Services ermltting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMITTYPE: �i U" u
PROPOSED IMPROVEMENT LOCATION:
Address: 'r`. 0 L , 3 L,9 -z
Property Tax ID#: :M i jggp I _66 /A _er)O –6 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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: Sq. Ft.of First Floor:
Cost of Construction:$ J�C����� Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name AtJL Name: /
Address: 7 Company: /
City: T"U{''�Sa��( `Ur(� State41 Address: 2 79 cl ,9_y-,'xm RA
Zip Code: 3 S Z Fax: AJIA City: Ko 1),-U State:_rL
Phone No. 772.– 2-LIQ — 15-39 Zip Code: 3` i Rl Fax:
E-Mail: Phone No 772 - 5-79 -2–LI47
Fill in fee simple Title Holder on next page(if different E-Mail 9_166rfLID&, AJ5 U'C_®0,6 1, Loo
from the Owner listed above) State or County License(—;'C 1 15
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.
SUPPLEMENTAL CONSTRUCTION.LIEN LAW INFORMATION;
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
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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 0 ner/Lessee/Contractor as Agent for Owner SikrTature of Co tractor/License Holder
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF COUNTY OF CGS
v
The for oing instr was acknowledged-before me The for omg instr met as acknowledgefore me
this day of 20 by this day of 20 by
S
me o perso making statement. N e of rson king statement.
Personally K wn OR Produced Identification Personally own OR Produced Identification
Type of Id(
tJb� n J Type of Identi al
Produced f G dl'l Produced ,
i
(Signature of Not Public-State of to id 1 (Signature of Pub' - a e.Qf.Flo6da
�sY AUDREY B HUMPHREY � y —AUDREY B.HU H�
Commission No. `° OMMISSII6G360817 I Commission N °' ; IV
MMI'SION f 100817
EXPIRES:March 6,2023 o�: EXPIRES:March 8,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19