HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / J
Date: 7 17 Permit Number_
zRECEIVED
- Building Permit Applic tion AUG 7 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPQSED IMPROVE_HENT LOCATION:,
Address: 316
Property Tax ID#:o?yoS 8• 6103- 001 a 0 00- S Lot No. Z± -
Site Plan Name: Block No.
Project Name:^ /rf L
DETAILED DESCRIPTION OF WORK
Lei .�
CONSTRUCTION INATI
FORMON:
,
Additional work to be performed ed u
nder this
permit mit
-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:$ S06 00 Utilities: —Sewer —Septic Building Height:
77777777777777-,
OWNER/LESSEE CONTRACTOR
Name Name:
Address: 0 ' Company:
City State: Address
Zip Code: 3�f 9�� Fax: City: State
Phone No. Zip Code: 3A&/ (S Fax: 77 g
E-Mail: Phone No V4,1-a777
Fill in fee simple Title Holder on next page(if different E-Mailh2,i' d&p .'d-e :e it,2c,�r,i e crr,
from the Owner listed above) State or County License E70- 1.300-.3, 59
87S
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.
DE5IGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: �X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _kNot 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 13E RECORDED AND
POSTED ON THE JOB SITE FORE THE FIRST INSPECTION. IF YOU INTEND T O TAIN FINANCING, CONSULT
WITH YOQR LENDER OR ATITORNEY BEFORE RECORDING YOUR NOTICE OF OM ENCEMENT."
inn,�4 �/,
Signa r6 of Owner/LesseeYeontractor as Agent for Owner S n ture of Contra or/License Holder
STATE OF FLORIDA ,�� j } STATE OF FLORIDA f
COUNTY OF E< C� L COUNTY OF /`, 6I el, y
The for9Qmg instru ent vas ac wledg�before me The for mg instru nt a2,
—nowledgefore me
this„�'--day of .2 0 by this l ay of l .20 by
Name of person making statement. Name of person making statement.
Personally Known r% OR Produced Identification Personally Known _�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
��&a _..*VA_ DeAm A PM
(Signature of Notary Public-State of FI � NOTARY PU senature o Notary Public-State of Florida}
� STATE 09 FLORIDA Commission No. 1�' ( Carm#FF92 ftmmission No. f� � `�S� (Seal APtW
Expires 9111 !2019 NOTARY PUBLIC
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA q@AF0URWWM
COUNTER REVIEW REVIEW REVIEW REVIEW REV[ ExpIltwEW11312011
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7119