HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 79h9 - Permit Number:
kii RECEIVE
Building Permit Application JUL 9 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department .
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie-,C/ountyl, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMITTYPE: W1 n 0
PROPOSED IMPROVEMENT LOCATION`:
Address:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: Y _ -YYI
DETAILED DESCRIPTION.OF WORK. K
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CONSTRUCTION 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 Construeion: imij Sq. Ft. of First Floor:
Cost of Construction:$ U ilities: S der —Se ti Buil d Height:
ONER `C
/LESSEE:
W , ONTRACTOR:
_. _ -
Name A I IS CC Name:
Add ss:� r . Co'inpany:
City: I A
Stat � d`dre�ss'•'� `'��::r,,.,,,•-a ., .
Zip Code: Fax: City: , ;y State:
Phone No. n_� Zip Code: ;Faz: `
E-Mail:. `� Phone No
Fill in fee simple Title Holder on next page(if different 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:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
.Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Applicatioh'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 ITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT,
WITH YOUR LENDYJOR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
SigngX&_E of-Ow /)Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledged,before me The forgoing instrument was acknowledged before me
this�day of 20 by this day of 20_ by
kh'i-i 1w-
Name of person maMing statement. / Name of person making statement.
Personally Known OR Produced Identificationy Personally Known . OR Produced Identification
Type of Idion pp�� Type of Identification
Producedi c tProduced
(Signature ofo a P HUM REY (Signature of Notary Public-State of Florida)
°'"do's, AUDR 1 #GG 300817
Commission No. s MWYCOM rch8 2023 Commission No. (Seal) -
m' ion; EXPI pubfio►lndetr+d��s
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19