HomeMy WebLinkAboutBuilding Permit Application All APPLICT7 INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit NumF:rE
V v(
KECE1% ED
• G 9 2019
Building Permit Applig Department
Planning and Development ServicesBuilding and Code Regulation Division e County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _ Residential
PERMIT TYPE: '
PROP:OSED;IIVIPROVEMENT LOCATION -
Address: 3 -5 .
Property Tax ID 4;�Ap s Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION O:FLEA
WORK a"
.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
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ $00. DD Utilities: —Sewer —Septic Building Height:
OWNER/,LESSEE CONTRACTOR
Name )J o� 'C1 Name:
Address: /: —
Company:
State:. L Address:
3CitY•
Zip ode: Fax:Fax: City State: .
Phone No. Zip Code: 6J Fax:'JJa-rf6/�a77�
E-Mail: Phone No 77a- 4(o/- a'/97
Fill in fee simple Title Holder on next page(if different E-Mail th Xt 09 PA ZJ AL—AC" r'
from the Owner listed above) State or County License G /900- Ss 9
d:
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.
Wit,'�^ `L.�;,- u` _'aax"'z`F _ moi*..,:1A!-"f g 4.��`Y'�--`t." rf -'S ,Z,. •rra.�7£ ...,.ti„'.a� a..r�: a c� ' '3."^' E r`T 'r r w�,,3 Zs_ z AN
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DESIGNER/ENGINEER: X 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: _)L&t 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 SITBEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR/AN TTORNEY BEFORE RECORDING YOUR NOTICE OF MENCEMENT."
S
Signat r of Owner/Less /Contractor as Agent for Owner Sig a ure of Contract r/License Holder
STATE OF FLORID f STATE OF FLORIDA
COUNTY OF_U 1149— COUNTY OF_��_
The fofgoing instrurpent wal acknowledged before me The foygping Instrunlent was aicknowledged before me
CXAthisay of ^,20 119 by this ay of 20� by
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
rro-11ced Prod
ad
(Sighature of Notary Public-State of Florida) ( ' atur of Notary Public-State of Florida)
�µ David Rayma d> �1 VSTATEOF
David R rue
Commission No. Cie-,��� o�"�Z NOTARYPU LIC it7 NOTARYP B
[54
Z STATE OFF 6RfbWission No. LIDA
Comm#GG 7052 ' Comm#GG 8'
2
cE 1 xpires xpires 6 23
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19