HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /• Permit Number:
- -7 RECEIVE®
Building Permit Application JUL 112019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie Cou y, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT TYPE: rn e G� 0 1
,PROPOSED;•IMPROVEMENT�LOCATION"t
Address: /-2l ,"hone fit/
Property Tax ID#: ��� / S coo -/- Lot No.
Site Plan Name: Block No.
Project Name: �> >/'L� I-
DETAILED DESCRIPTION OF WORK
Ale-,-- 3 T-2; _2 ,fes ,C /c141
CQNSTRUCTIONr FORMATION _ 9 �+
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: ��ff Sq. Ft.of First Floor:
Cost of Construction:$ &V- 6 Utilities: _Sewer _Septic Building Height:
OWNERLESSEE = CONTRACTOR
Name a,Se- Name: +=jl{ '� )` , "P40SC-7Z...
Address:fol/ 424SY- .4RAQ a AV Company: jf::-f1"l".�w
City: !`7 f State:;�L_ Address: r i C OC
-
Zip Code-3c/7 602 Fax: `� City: M ICio li Staterr(._,
Phone No.F- `-���1- 7 Zip Code: i Fax:
E-Maims�oSirzen/��rz��a7.�fG./. cn�-•- Phone No r7t 49
Fill in fee simple Title Holder on next page(if different E-Mail If4011C,C_-iI r`( G �,+rl_f!1 from the Owner listed above) State or County License
�`I�"ft-�iC�' I
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. -�� ��
•1Yp�s IVETfELORENZO
_°• 4�'- Notary Public-State of Florida
Commission#GG 230691
My Comm.Expires Jun 20,20''
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SUPPLEMENTAL CONSTRUCTION UEyN LAW INFORMATION x
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 pool,fences,walls,signs,screen rooms and accessory uses
��too another non-residential use
"WARNING TO OWNER: Y AILURE TO RECORD A NOTICE OF COMMENCEMIEa MAY RESULT IN YOUR PAYING
TWICE FOR IMPROV EN)rS TO YOUR PROPERTY. A NOTICE OF COMMEND-EMENT MUST BE RECORDED AND
POSTED ON THE J B S�fE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR O AN ATTORNEY BEFORE RECORDING YOUR NOTICE,OF COMMENCEMENT."
. ./f
Signature of Owr&W Lessee/Contractor as Agent for Owner Signature off Contractor/License Holder
STATE OF FLORIDA STATE OFFLORIDA
COUNTY OF O C(fnl COUNTY OF
The forgoing instrument was acknowledgecJ,before me The forgoing instrument was acknowledged before me
this y of 20 by this V. day of _j(_A-j 20111 by
Name of person making statement. Name of person making statement.
Personally Known "--OR Produced Identification Personally Known L—'- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature public-Sutumfollbrma) (Signature of Notary Public-State of Florida)
• • �= Notary Public•State of Florida
• o` Commission#GG 2 1
Commissio $? P: 22 CommissiofAo�
S'o •. LORENZ0 Sea
ires Jun
Bonded through National Notary assn. Notary Public•State of Florida
a= Commission#GG 230691
My Com Expires Jun 20,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS E6E1�4PI1rou h�l sn. ANGROVE
COUNTER REVIEW REVIEW REVIEW I EW- IMWIEW REVIEW
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