HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: T a � Permit Number
lF%&%a4F=AVEM
~� JUL 2 4 2019
Building Permit Applic tianmitting Department
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE: l % GbV
PROPOSED-IMPROVEMENT.LOCATION=
Address:
Property Tax ID#: 3q lot - 57 C')-C�)b l- -c 0010 Lot No.d-_
Site Plan Name: Block No.�
Project Name: irk rook)
DETAILED DESCRIPTION OF,WORK'
UU
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_,Mechanical _Gas Tank _Gas Piping _Shutters _Windows/ oorrss
_Electric _Plumbing _Sprinklers _Generator oof `� Pitch
Total Sq. Ft of Construction: ! Sq. Ft.of First Floor:
Cost of Construction:$ JUtilities: —Sewer _Septic Building Height:
:OWNER/LESSEE 1 CONTRACTORi 1 .
Name e Name: l ��
Address:m0 vC, Company: t -,U
City :C:�)— State Address: I
Zip Code: -�QCI P,--S Fax: City:YQw 1,
2p,� State:
Phone No. =7�� t2 Zip Code: aQ&a- Fax:
E-Mail: Phone No `'( c3-'l_.e
Fill in fee simple Title Holder on next page(if different E-Mail W-e
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 CONSTCTION LIEN LAW.INFORMATION ,
? ..
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 LEN6ER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
�igCnature of Owner/Lessee Itontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDAf 1
COUNTY OF -� tv:Q COUNTY OF , _�-Ulot �—
The�going instr ent was acknowledged before me The forgoing instr ent was acknowledged before me
this ((Ldayof 20_ by thi day of 10T,
( 20_ by
,Y A�
Name of person making statement. Name of person making statement.
Personally Known -®R Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
171 B
gnature of NotaLP6'_ ' atercirfdelhderson (Signature of Notary Public-S
My Commission GG 211256 r Notary Public State of Flon� Expires041 20 QCommission No. S�ea17� Commission No. & � � a P Sanderson
wv� TV o mission GG 211256
Expires 04/25/2022
O►M1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.