HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l�� I Permit Number: qft
RECEIVED
-�- -- --- -- Building Permit Application
AUG 19 2019
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
PERMITTYPE: 4z_c6o F _S� /L Ie-
PROPOSED
ePROPOSED IMPROVEMENT LOCATION: L
Address: SU( Z_,1jj,VA, 1:LAX 251 at,PG
Property Tax I D#: SH I(D 5-03 63 O S 00-0 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
" -to -�L4_ a ce-I / q4,,dC J,4oieA�
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 L--Roof5✓ Pitch
Total Sq. Ft of Construction: _gc�z Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
OWNER LESSEE. CONTRACTOR:
Name . gePj< Name:
Address: Su u Z"WIMl/ ),Anc_� Company: L b
City:_ R (?ru/6"e— State: F( Address: 19/73 50 G�e�c�eGe,
Zip Code: 3-(992-- Fax: City:`/ty'-F 6-F Stater
Phone No. Zip Code: 3'x°(0`7 Fax:
E-Mail: 'Phone No7Z2, r1_0 4
SNr565
Fill in fee simple Title Holder on next page(if different E-Mailm (t,, V "ce–
from the Owner listed above) State or County License C' l3 11 -1 o
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 YQUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/-Lessee/Con 7!rs-Agent for Owner Sig ature of Contractor/Licen H61 er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF C
The fopyZoing instru ent as acknowledge before me The for oing instru entwas acknowledge before me
this day of 20 by this day of 20I I by
Name of person making statement. / Name of person making statement. /
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification ✓
Type of Identifi n Type of Identific n
Produced Produced
(Signatu a of Not Pub ic-State of Florida) (Sign ture of Notary ubli
KARW NIELSEN `�4ppY Py���
KAREN S. NIELSEN
Commission No. o`oAYP� �tt�b il- tl;SC gf,,�i onda-Notary Pub is
tate of � a-Notary Public Commission No. _ ._ Co�FrfrS�ion # GG 20748
:• Commission #GG 207484 ;
sem= ssion Ex fires �;o����;• My Commission Expires
2 2022
June 12, 2022
REVIEWS FR 8 SUPERVIS011 PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19