HomeMy WebLinkAboutBuilding Permit Application t
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED S
Date: A •1� Permit Nu r:
. - JUL 2 2019
- -- -- - -- Building Permit Appl cation
Planning and Development Services Permitting 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
PERMITTYPE: _D JeJ�ll
PROPOSED 111%IPR "", LOCATI4Iv
..<.. ,«s., ..w ,. ot ._a-T
Address: CL,I') V,1 V o r
Property Tax ID#: s-D a n a a Lot No.
Site Plan Name: Block No.
Project Name: �tI
,a-::- s h ,yal`' . 4d ro T xri r .f i s y r x
�pE3TA{LED DESCR{PTIQN�OFWORK �
cX l
PJ6ONST=RU �, a0N INFORMATIQN � xx ,s
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:A�o Sq. Ft.of First Floor:
Cost of Construction:$ 9S 00 Utilities: —Sewer _Septic Building Height:
'yOWNERAESSEE tw" � ONTRACTOR
... :1..
Name ac - (I c ti _ Name:
Addre�: S M-i � r Company_
City: I QTY State. Address:
Zip Code:-5 Fax: City: ' ' `' State:
Phone No. 3 Zip Co.Be' .: . ' < . ..,:.Fax:
Fax:' i
E-Mail: `Phone No
Fill in fee simple Title Holder on next page(if differen E-Mail
from the Owner listed above) State or County License
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
Name: Name:
'Address: Address:
'City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE TITLEHOLDER: _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 ORA ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lesse /Co racto as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instr nt was acknowledg�y efore me The forgoing instrument was acknowledged before me
this day of 20/ by this day of 20_ by
n. lim
i
Vrs,ersonally
e of pe on making statement. Name of person making statement.
Know OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifica nType of Identification
_
Produced - 6 Produced
(Signature of of r Public-St-M-of Flori (Signature of Notary Public-State of Florida)
Commission N AyDREY!. VMPit
MY MMISSIO ew 300617 Commission
Commission No. Seal
;,;
:;? EXPIRES:March 6,2023
''lEOFF��••' Bond Thru NOWY
REVIEWS t NG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
II