HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numbe . O (---D--
�--- -- RECEIVE
Building Permit Application
JUL 112019
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
PERMIT TYPE: W 1 r•. t 1
PROPOSED 1'MPROi/EMEENT LOCATION.
Address: '2-Q, 2pf cfin �PYV e_ Rsv-t S+- tic-u- R-- X9
4
Property Tax ID#: S—l\ \ " SM - 0093 r 00L Lot No.
Site Plan Name: Block No.
Project Name:
D TAILED DE�SCR�IPTION Of WORK:
CONSTRUCTION I 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: �5) � 0 5� Sq. Ft. of First Floor: �—1�0 S�
(� {
Cost of Construction:$ 1`" 150 Utilities: _Sewer VSeptic Building Height: l Svbrty
OWNER/WESSEE: CONTRACTOR:
Name Qi Md t&VNkSkY\QS Name: k.�vriv-Nc,�_�f-�
Address: '?)'1:060 �J1,1S�1(��SS �ti— tibV- Company: Asx- C' S rLJLC+\-SCI
City: U-- \2, State:I� Address: <A00t'-1 NW NoY-AVn (V\A C ec o
Zip Code: W151L Fax: 111-205- )za:8 City: Qw-�— sv we--\t' Stated--u—
Phone
Phone No. --y—Z—qS,�; - GO i S-lD �, Zip Code: �`�Q�S Fax:
E-Mail: ('' ��n & nSrnkn%s+rM 6)CA�'�Cll���t Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C.czIc--
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 CONSTaUCT[ON 11EN LltV !lFE7RNiA�fE�N ,
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/CONTRACTORAFFIDVIT: 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."
SignatureOwner/Lessee/Contr o as Agent for Owner Signature of ntractor/License FrafAr
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fgrgoing inst was acknowledged before me The forgoing instr t was acknowledgedbefore me
this 1! day of 20L�•by this day of 20) by
Nam f person aking sta ent. Name of erson making statement.
Personally Known OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Type of Identification
Produced Produced
4a"
ignature of No0&2ffRRt?'
FloridMSD—PERVISOR
(Signature of Notary P c-State of Florida)
Commission No. REY��SSCommission No :'' �"` °; AUDREYB.H EY
MMISSI = MMISSION#GG 300817
PIRES:MEXPIRES:March 6,2023
hru Notanded Thru Notary Public nderwritors
REVIEWS PLANS VE OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.