HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V
n
Date: ' �• Permit Numbe
id
SEP 12 2019
- - _ Building Permit Appli ation
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Co ty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
V.i K-9 100-5 @ I D1 IMPROVEMENT LOC,_ I1Oa
Address: l'
Property Tax ID#: �Zia�-��7 ! —C -�7� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE=�SCR�IPTItON OF WURK:
d6,-1 —
IMN::-SZTR,IIV�CoiTIC0,Nil�N,'�FO,'R,,M',ANTION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
1
Electric _Plumbing _Sprinklers _Generator. '4o
of Pitch
Total Sq. Ft of Construction: 1 �y Sq. Ft. of First Floor:
Cost of Construction:$ 0 Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name !1 GJ Name.
`A'ddress
State: Address:.x
Zip Cod .,
e: Fax: Stater
Phone No. �_ /L��C �� 7U a:< .e w., Zip Cotle:rFax: r
E-Mail: Phone No
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.
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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI vr-� L STATE OF FLORIDA `
COUNTY OF LcU-e-& P- COUNTY OF
The forgoing instrument as acknowledged before me The forgoing instrument wps acknowledged before me
this_1g; day of 201 by this 1c day of 20L by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide tification Typeof Ide tification
Produced —���-��-331 O Produced(/ ln&�Z_— /2� ✓ ,
JAVAN BELL,JR,
(Signature of Notary Public-State o of Notary Public ,t'ari A
Qti JAVAN BELL, R. •;,F oP, IRES:May 28,2022
f�{D�'"1 � MY COMMISSION 28 2� i its n No. ,o"` ,•• BondedTh NataryPublicUndznvr.te
Commission No. �� :' EXPIRES:May C
TI"Notary Public ndomflers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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