HomeMy WebLinkAboutBuilding Permit Application All APP ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: I Permit Number: CL
OIL 19 iVEsa
AUG 19 2019
Building Permit Application
ST. Lucie County, rmitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: I�JCJ4(1
MOPOSED !PR01/I ' WENT LO ATION:
Address: :! 5PO
Property Tax ID#: 100.27 Lot No.
Site Plan Name: Block No.
Project Name: oeefrFe 114
D TAILED DE=�SCftdPTION U WORK:
CONSTRUCTIWN INROM',ATION:
Additional work to be performed under this permit–check all that apply:
• y. r:
_Me anical _Gas Tank`' _Gas Piping _Shutters = _wndows%Doors
lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 1900 Utilities: —Sewer —Septic Building Height:
OWMi,ER/LEWSSEE: CO TRACTOR:
Name aAA)a.Moyq., o,%ay l e L�,� Name: 2
Address: Company: fXt[1G
City: ►Id.( �!►C,(�• Stater Address:
Zip Code:: :�t
Fax: CityState- /
Phone No. Zip Code: 3 Fax:
E-Mail: Phone No itL . 44 _. L �. o,:---.---_.-•-
Fill in fee simple Title Holder on next page if different E-Mail G \R'\(��',' ' (whi
from the Owner listed above) State or County License'
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.
PP TA CO RU O W INFR N:
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 rples,bylaws or and.covenarits'th'at'may restrict:orprohibit 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;l do hereby agreeithat 1-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;sc�een'•r000ms'and accessory uses to another rion-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. I YOU INTEND TO .OBT FIN LACING, CONSULT
WI Y UR LENDER OR'AN TTORNEY BEFORE RECORDING: OU NOTICE-0E--1 �EME "• --
Signatu a of Ow er/Lessee/Contract o as Agent for Owner Signa a of Con ctor/License Holder
STATE OF FLORI ST TE OF FLORIQA
COUNTY OF W� C UNTY OF MT WLtE
The forgoing instrument w s ackn wledged before me The forgoing instrument was acknowledgbefore me
this day ofd 20t'lby this day of '�'`�tNg�' 20 by
L--1 r 4 Z I
Name of persob making statement. Name of persod making statement. /
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of Ide ' ' do Type of Identific 'on
Produced Produced t L DL
(Signk&E
PU. Iic='S at' o F r' a (Signature
„���1,, ;� �P�a', KARE EN
yp� AKA RE'I�•S. NJE •S N�" _ o ,- State of.Flotido-.Not<ar Public, _
Comm ' ida tVotl �69ic Commissio R3 `= on # GG l4
*c Commission'#,GG 207.484 =,, Pec My Cornmission Expires
+� Pc M Commission Expires �% P`;�°�`
Jun 12 2022
Ju ie 12,`2022`
REVIEW ERVISOR PLANS VEGETATION SEATURTLE MANGROVE
�;;;- . .;COU,f�TER;... RE.V;IEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ` f..
RECEIVED
DATE
COMPLETED
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