HomeMy WebLinkAboutBuilding Permit Application All APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: `�• 1 1 Permit Number:
IICYI
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RECETV80
_ Building Permit Application
Planning and Development Services AUG 14 2019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Permltiing
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: 1)e>C.A�o�.. ��LSL/�� L -�YQS
PropertyTax ID#: 1 S6 l • Mql- ®(3Q "g Lot No.
Site Plan Name: Block No.
Project Name:
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:$ .q SO,(�o Utilities: Sewer Septic Building Height:
T
Name Name: L
Address: 610 4 (� Company: '( LQ
City: State: L Address: ti S„S41.A QJ
Zip Code:3Sy Fax: City: J 'C State:'E .
Phone No. Zip Code: 3 y.�5� -Fax:
E-Mail: Phone'No ��`Z �-a3 `�'6 8,•.
Fill in fee simple Title Holder on next page(if different E-Mail NO, �,Jj- g z' Cc,c,,,,c
from the Owner listed above) State or County License C-N C 1 M 4'�So
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.
HISill 111,11''!Ill lHill 1111
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 deedfor 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."
Sign af e of Owner/Lessee/Contractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing inst ment was acknowledge efore me Theo oing instr en was acknowledge , efore me
this�day of 20_11 by this day of 20_by
1�imF 1
Lag) lu M S KI D
Name of person making statement. Name of person making statement. /
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of(dent' ' Type of IdentL�do
Produced t L b1 Produced
r
(Signat e`gPYPp ary F 1 (Sighat e gft�p4ary Pl( ii ale r -
_State of Florida-Notary Public _State of Florida-Notary Public
Commi i Commission # GG 211$4@4 Commis Q Commission # GG 20XS&,m1
My Commission Expires OFf�°Q y ornmission Expires
''011" June 12, 2022 June June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE 'MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.