HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l � '' Permit Number:
T
l
R e�`
- _ 2019
Building Permit Application JUL I
Planning and Development Services permltt��g pepaitment
Buildingand Code Regulation Division COL. '
9 St. - •`-
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PRfJ'PUSED! R� E ENS LQCATI
Address: -3tg
Property Tax ID#: 10: ^ Coto ^ 0 M 1. ^nZ� Lot No.
Site Plan Name: Block No.
Project Name:
1QE AILED 11W RQPTIO O@,RK:
r 0 M1&N
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CLQ `S1'RUCT t�N INFOR TON:
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:
0 ERjLE��S
VMS 22T112
Name n5' c�q/` Name
Address: Company:
City: e State: 'LL Address:
Zip Code: �jCjC�C�', Fax: City: State:
Phone No. —QOQ Zip Code: Fax:
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.
I
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 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."
J
Signature o wner/Lessee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 5V Lu i,!e COUNTY OF
c
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of LJ 20_jQ by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati �� Type of Identification
Produced Produced
f
(Signature of Notary rub-1State of Florida) (Signature of Notary Public-State of Florida)
Commission No. C,ora-7 (Seal) Cofission No. (Seal)
ELLEN VAUGHN
REVIEWS FRONT =_ 'E CO n #GG 270079
Md s` �� at pir9A VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19