HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED- -
• - JUL 2 9 2019
- Building Permit Applicati n
Planning and Development Services ST.,Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT TYPE: C_
PROPOSED IMPROVEMENT LOCATION: A
Address: �I�� `'� 0k\N e- Ao
Property Tax ID#: MCI- 001- ZJ "`(0('10- Lot No.
Site Plan Name: Block No.
Project Name:
_DETAILED DESCRIPTION OF WORK:
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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
"W7
Total Sq. Ft of Construction: Sq. Ft.of First Floor: _.
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Cost of Construction:$ �aS 0 Utilities: —Sewer _Septic Building Height:
.OWNER/LESSE-E: 'CONTRACTOR: . . ;
Name Name: J A.
Address: W210 llfd,-Q Company:
City: TA--- t State: V-L- Address:
Zip Code: 2ki 9.S'/ Fax: City: C.-- P.LQ-, e) Stater
Phone No. OXYD- Zip Code: NyD- Fax: -97,gL-
E-Mail: Phone No —
Fill in fee simple Title Holder on next page(if different E-Mail lqC`nt e-5- (.R-0,Giw\from the Owner listed above) State or County LicenseC
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: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 INSPECTIO JOU INTEND TO OBTAIN FINANCING, CONSULT
YOUR LENDER/QR AN ATTORNEY BEFORE RECORDIN YOUIP NOTICE OF CO MENCEMENT."
Signat a of owner/Lessee/Contractor as Agent for Owner Signatu of Contractor/Licens Holder
STA OF FLORIDA STA OF FLORIDA
CO TY OF COUNTY OF w�;
The,forying instrulVent was acknowledge before me The for oing instru�nen was acknowledge before me
thi day of 20� by thisrA day of J 20 by
( �Ric'n Kk �,�' �_�Bsow I SA, USE-
Name of person makings tement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature ptary u $ r EN (Signatu. KAREN S. NIELSEN 3.t
SP Ug `\\11111/,, S��
_?_° _State of Florida-Notary Public �o�Pp POa%;State of Florida-Notary bbl+'
Commissio ; Commission # GC(S��184 Commi, = # GG 2� F
oQ`.� y ommission Expires "� �� My Commission Expires
'��°iii\\`� June 12, 2022 �'.'``oF.—
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DATE
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