HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION TO BE ACCEPTED 1
DatePermit Number:�� 13i�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERIVIITTYPE:
PROPOSED IMPROVEMENT LOCATION`.;
Address: 3_7? i a 12Cyai ,e...
Property Tax ID #:. d L�3 3.-- S713 - O oo
Site Plan Name: �1��VK�V� ( �S VY11/h,✓V
Project Name:
DETAILED DESCRIPTION OF WORK:
Commercial ✓' - Residential
= ID ov
Lot No.
Block No.
LJ/ -H 0 6 V A Vzu Vv -�TrrAaI.A
CONSTRUCTION INFORMATION;.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric ✓Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First .Floor:
Cost of Construction: $;, ay Utilities: . —Sewer _ Septic
_ Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE-
CONTRACTOR`:
Name V Jti
Name:
Address: 37 b (2)t g ✓ Ark.,
A-LT4
City: F4 . c-e_ Ve_,e State: ESL•
Zip Code: 3q g R i, Fax:
Phone No. 77R, Of 89
E-Mail:.
Address: 31/� I ��t'_(V
✓/� 2.
City: Pk &e i1g e_
Zip Code: -6gA9`2--
Phone NoZ72-q (of-Gtob�—
Stateyil
Fax:??2-q&t-1'011f
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:irL 1,tmhthct8
6e,I
State or County Lice nse(i,P 3S'7 9S
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.
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SUPPLEMENTAL CONSTRUCTION `LIEN . AW 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 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."
0!4,4vl�,
^tor
Signature of Owner/ Lessee/Contractor as Agent for Owner
signature Con 'ra Licen e Holder
STATE OF FLORIDA
COUNTY OF `_�'�"_
STATE OF FLORIDA
COUNTY OF '5+. Li,&tLe,
The forgoing inst ent was cknowl edged before me
this day of 20 LEI by
The forgoing instru ent was acknowledged before me
this z4"�day of 1,t5 20 19 by
aVa LI eJ
Vaal
Name of person making stat ent.
Name of person making state t.
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
%A4 _Mmwn�
Type of Identification
Produced ARLENE RIG SBY
;t: MY COMMISSION # GG 085
3f' EXPIRES: June 13, 2021
:+rFOF d�•�P; Bondcd Thtu Notary Public 11
58
ature o N ary Public- Sta 4,1', td 11 PLEENKRUEGER
Commleslon 1t GG 345719
Commission No.C-Z�YS_17 i 5,r resJune 17,2023
'•• ��;�•••• landMThNtnlrFeMlnsunnra
(Sig ture of Notary Public- to f Florida )
9� ission No. C-T-& 0&<, (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2 7 19
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