HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE
))INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: //o2sl f+ Permit Number: �CINS
I
W,1111�11111111`+ ` _ oxo % X019
_ Building Permit Application p�pa<tt�e�c
Planning and Development Services pC 0*\r�`g e °Urtl
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSED lMPRO EMENT LOCATION:
Address: /IDS Oe,,4 W6.nA L Al
Property Tax ID#:_3 W)q - SS q Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE-SSC■RIPTION OF WORK: I
(r lr n o O K c i�i nl cn r td4k S-al4e-
OONSTR CTIONI IN -ORMATION:
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: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: OONTRACTOR:
Name Rie-hcrA J Name:
Address: 5W 1g7h Company:
City: lSoce' 440tj State: Fl— Address: V/ 16z/-AJW &1 iaij
Zi Code: Fax. City: .� State: L
Zip ��qe(— Y i �L
Phone No. Zip Code: Fax:
3�/ctSs�
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail 4 ech c4&L45ie, r
from the Owner listed above) State or County License 2
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.
i
I
S PPLEMENTAL CONSTRUCTION MEN LAW 7Na
DESIGNER/ENGINEER: Not ApplicableTGAGE COMPANY: Not Applicable
Name: e:
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 thepermit 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."
�_��� %dc?,lam_. N� ✓
-Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C3� '��- COUNTY OF
The forgoing instrument was acknowledged before me The fo__rgo�i�ng instrument was acknowledged before me
this Gy of
�^ -�( X20 by this `1 Kday_of &W_," 20_ by
Name of person making statement. �- Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
ProducedProduced ��
1
(Signature of Not (Signat N ary Public- to of Florida)
oMpav'r.1*"I ELLEN VAUGhiN
finf, 0 of Floe�� trary Public Comm •� �0, EI 1 c« (Seal)
Commission No. «- 079 orate of
"Cl. P�` My Commission Ex '_
unM pir®g �• oma; Co
Florida-Not.;
nnu" Y Com a .•
REVIEWS FRONT ZONING SU OR PLANS °b r .; RT•L•E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW i. REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 2/7/19