HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE JINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i rU -7
� Date: �' l
Permit Nurr b
T AUG 2 9 2019
Building Permit Appl n ent
Yet�rnitting Departm
Planning and Development Services �t, Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
,,PROP.t?SED gVIPROUEMENT LOCATION„ ,
Address: C1�� ` �V�h �i1��. �^ Y
Property Tax ID#: 3a'L 503yij-7 k3 00 Lot No.
Site Plan Name: .. Block No.
Project Name:
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DETAILED DE
SCRIPTION C}f V1fORK
,.,. •
CONSTRUCTION 1N'F0RMATION
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:$ l7 OUB Utilities: _Sewer _Septic Building Height:
QWRlERjLES5EE CONTRACTOR
p_
e
Name _ v. Name: x
Address: � � � Pyr � '�c�`^ Company:
City: �� Qre�•-- State' Address: 3Z)1 S� }A ��1
Zip Code:3�1� Fax: City: S1r- State:
Phone No._)19 Zia%-*010 Zip Code: `� �4c Fax:
E-Mail: Phone No—_)'_)�)L-- SQI�
Fill in fee simple Title Holder on next page(if different E-Mail
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.
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SUPPLEMENTAL CQNST UCTIQN,LIEN 'LAW INFC?RMATION b> � . � �4,�
�.
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.
1 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
f 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 NQTICEOF COMMENCEMENT."
--�.`-=.'?'"-��`'^�—•-,yam--.._
Signature of Owner/Lessee/Contractor as Agent for Owner Signature df.C ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA_ )
COUNTY OF jn,ie COUNTY OF
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n m le
The forg�oQing instrument was acknowledged,before me The f r ping instru nt was acknowledged before — C a
this aR f iday of A\)19.()- 2019 by this day of 20 by F�m M) ?,noc
F rn S2
c ^ O C
Name of person making stat6ment. Name of person making statement. -C-3361
c- �x
c o w;o
Personally Known OR Produced Identification Personally Known OR Produced Identificatic i " 8 E3
Type of Identification Type of Identification
Produced Produced
(Signature ofWotary Public-Stam c ' re of Nota P ic-State of Florida
otary Public-State N }
:* Commission#GG 07829
Commission No ' ',al}My Commission E (Cib"miion No. (Seal)
June 22, 202
REVIEWS FRONT ZONING - SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19