HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: G'1' t Permit Number: q 0 o
K E IV E
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Building Permit Applica ion SEP 6 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Co nty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
hce-
. .,d IOCA aN:
Address: 55 OS ✓-e-
Property Tax ID#: 3 L-1 0Z & O 0 -7 `3 0015 4/ Lot No.
Site Plan Name: Block No.
Project Name:
C* 1 ' t• O W(OR
- .1 156"? 1 I �7 ' `O� z-/` j" J6 e!- /-iii/l. 6-7�_2
tO S C PfJN N OR,MA N:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank- —Ga s Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 10 C>,.D 0 Utilities: _Sewer _Septic Building Height:
SM X01
Name _�D �1 jMd ��� Name: ���f�1. ,lSU�aC,/
Address: 5-q05 �G�r�vc%� �t�ir/<% Company: Dbs1'-Lck 6C'e-75 '-eeC-k'ar7
City: / � l�iri�c2. _... .... State:_,Cl, Address: q1 ,SW
Zip Code: ��-07- ;Fax:'. City: PSL Stater
Phone No. � 3 S�" �� f Zip Code: ���i �3 Fax:
E-Mail: Phone No (-7153 630— -2(105
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License CC- (!5
d Z 6
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.
UP LEMEN AL C«ONSTRUCTION LI �N LAWiNFORMA IO
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 AFFIDAVIT: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
POS ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOUTEND TO OBTAIN FINANCING, CONSULT
WITW YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT_"
Signature of..O ner/Lessee/Contractor as Agent for Owner Signature of C,, ralor/License Holder
C,,
S,TE ORIDA STATE OF(FLORIdA
C�OU,�ITY'OF lP/C�.E� COUNTY OF i
The for oing instrum t was acknowledge }before me The forgoing instrument wa acknowledge before me
this�day of 20/`I.by this&day of 201 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification L/
Type of Iden i i i n Type of Identific io
Produced Produced C -
(Signature of Notary blic-State of Florida-) (Signature of Nota ublic-State f FI r' a
li�Y?ya AUDREY B.HUMPH EY
Commission No. ;tpYPG c AUDREY B( 11�HREEY Commission No. = °'_
MY COMMISSION#GG 300817 MMISSION�#� 0817
EXPIRES:March 61-2023
a' EXPIRES:March 6,2023 .F•.-•oP:
Bo ded Thru Notary Pubic Underwriters
�s..wa awct:wszsi
REVIEWS rnmrV SOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 277/19