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HomeMy WebLinkAboutBuilding Permit Application All APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Perm5(oit Number: - on I �-- --� RECEIVED AUG 0 2 2019 _ Building Permit Applicatic 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: Address: •�j Z�/ / vim' ©ff /G L Property Tax ID#: z 00 S-1 O — 01 Lot No. Site Plan Name: Block No. 11 Project Name: u x,Cyi/�Sc% 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: J-22 05F Sq. Ft. of First Floor: Cost of Construction:$ Z cf a o Utilities: _Sewer _Septic Building Height: 111111111111 11,1! t-W , - Name Name- A/G P �— Address: �/. .>+%w.. 7iw7 t Company: G7G7-S L L City: /0,1L >T 6 `Gi State: L Address: Zip Code: 3 C/.57 B 3--:7'Fax: City: State: cz c— Phone Zip;Cbde:*,a ra.,q'g Fax: E-Mail: Phone'No Fill in fee simple Title Holder on next page (if different —� „E=Mail Tali/`;L"I t s" /J 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 I Wil =� Nmm� _ ..s 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." i Signature of Ow er/Lessee/Contractor as Agent for Owner Signature of Contr c or/License Holder STATE OF FLORIDA STATE OF FLORIDA , 1 COUNTY OF �� ,(l✓ COUNTY OF ��� C I Thef rgoing instr me t was acknowledged before me TheEGG6+0 ing instruent was acknowledged-before me is( day of 20by thisday of 20 1 by n MI)*00 Name of person making statement. Name of person making/statement. Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Public-State of Florida) (Signature of Notary Publi , on REN S. NIELSEN =o`PY IN vI" :State of Florida-Notary Pub i Commission No. mission No. _* C#e�4sion # GG 20748 KAREN S. NIELSE ''9'EOF f,� Ivty Commission Expire ,,,�%` Jurle 12, 2022 State of Florida-Notary Pu lic Tl =* �= Com fission # GG 20784 REVIEWS FRONT " � fINCMy C)riff' fir s ANS VEGETATION SEA TURTLE MANGROVE COUNTE un IEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.