HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O D-
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Date: (JUI� 5 ad ��� Permit Numbe : I
RECEIVE
_.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
JUL 5 2019
Building Permit Applic emitting Department
St. Lucie C�aunty, FL
Commercial Residential
PERMITTYPE:
PROPOSED IMRROVEIVIENT LOCATION`
Address: IOR &y. P—As Ra Aukcht-nioln 3LAR0
Property Tax ID #: Lot No.
Site Plan Name: Me'C&C• Block No.
Project Name:
DETAILED, DES.CRIPTION:OF WORK
CONSTRUCTION INFORMATION x
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: $ dZ y(% , p 0 Utilities: —Sewer —Septic Building Height:
Name _ 1 / c,nc y,
Address: 60 �o�% "
City: qM A-e,%NN wS Dr 7�--K l State: F U
Zip Code: - 1L( 6l LA 1 Fax:
Phone No. --6,35--'14a6 0
E-Mail: 753 0
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
,CONTRACTOR:
Name: ���✓ �- �y
Company:
Address: 2-14.1
1 r,
City: 1jlAe6
State:
Zip Code: � VET 7 Fax:
Phone No �i 2
E-Mail
r-
State or County License !/
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required. �� r?
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPi'LEMENTALCQh§,rRUCTif31tl i.IEN t 111/ i�Vix�RM/
TiONTr ;
Y P S a
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 'Lessee/Contracto _aJA` nffor Owner's
CSigaature-of-Contractor/Lice a fiolder
STATE OF FLORIDAy
VI,F�
STATE OF FLORID�I�
COUNTY OF (,�
COUNTY OF 1J1�L�'I
The f�j,�,oing instrumen -was acknowledge before me
The fo oing instrument was acknowledged before me
ZW
this �"� day of �L 20�1 by
this day of TQ L = 201q by
M ANTI �J S V8S
Name of person making statement.
Name of person making statement.
Personally KnownZRProduced Identification
Personally Known !/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig a ure of Nota Public- State of Florida) JENNIFER
E( of Notary ublic- State of Florida )
�SpRY
Commission No. CT 3Uc?
NOTARYP
JENNIFER E
BLIC fisson No.�'�r�%5J-11 NOTARYPU
STATE OF
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