HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - Permit Numb • 0,53
K C E IV Em:D
•
• AUG 2 6 2019
- Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
,PROPOSED IMPROVEMENT LOCATION;
Address: 5 . i /,. ?' �L �2
Property Tax ID#: 2_ '-1 35-- Q d n:3 - 0 Q Q -- 7 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ca,(LA,t 2 /1� ,
CO-NSTRUCTION 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:$ ��` Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:,, CONTRACTOR:
Name i'2l Cu)) r a Name:�2� 2 SSS
Address: y O Company: 1T f cl^. 3�Q /!e
City: State: FC Address: -2_7$q 'D2V",�Aj,*_ 'Rb
Zip Code:-?11 ° 92, Fax: City: 1� r--f- /ni e.r-ce State:fiL
Phone No. 772-- ,5 30 - !Z" 17 Zip Code: 3 LI99 1 Fax:
E-Mail:V,-�a e)t102a ck-p,1, C&m Phone No '7 72-- S7 q --;q6'2-
Fill
6'ZFill in fee simple Title Holder on next page(if different E-Mail W eL' W 6 r--fA oldm k A)u j/g_ )CLO�.gin
from the Owner listed above) State or County Licensees mg 1S
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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Ow r/Lessee/Contractor as Agent for Owner ignature of-'n-tractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF COUNTY OF
The fr,�going instru ent was acknowledgefore me The forgoing instrurrigot was acknowledged before me
thisc qday of 20� by th' day of 26 L by
Iwo , P:4L
ss -�--
Nary} of&son ma Ing statement. Na e f p son making statement.
Personally Known OR Produced Identification Personally Known `� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
0
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(Signatur V (Signature of o -
o<• °`�i AUDREY B.HUMPHREY AUDREY B.HUMPHREY
;.: MY COMMISSION#GG "
Commissi ;EV _ 3(IH18�) Commis oI�' �YCnnnnnlssloN#GG3000e )
9rF oP S:March 6,2023 ;"s. EXPIRES:March 6,2023
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Landed Thru Notary public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW`' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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