HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST,BE-COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: �• q Permit Number: I 1
ru - E cEcC_`►_VI D
_ Building Permit Applicati n SEP 2 0 2019
Planning and Development Services Ssa Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,-Fort Pierce FL 34982 /
Phone: (772)'462-1553-Fax: (772)462-1578 Commercial Residential ✓
PERMIT TYPE: �� �
•
Address: -041 0
Property Tax ID#: - Q �" Lot No.
Site Plan Name: Block No.
Project Name:
Aie Al
- f-
I
iffi=1 �111=-
Additional work to be performed under this permit-check all that apply:.. . .
_Me chanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator, _!R'oof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First.Floor:
Cost of Construction: $ Q-I( Utilities: —Sewer . Septic Building Height:
Name 1\ A -
Name:
Address: ry ! company,, -
City: State.F(— Address: '`i ?_
Zip Code: Fax: City: ' tale:
Phone
Phone No. Zip Code:
E-Maillhuoln Cw' \.I-cLL o in 'C rt' 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.
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 permitto do,thewdrk afnd 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 ahy,restrictions which may apply.
In consideration of the granting of this requested permit, I clghereby agree"that I'will'Jh'alLrespects, 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
WIT,K YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT'."
Signature of Owner/Lessee/Contractor as Agent for Oyvner Signature of Contractor/License Holder
STATE OF.FLO .IDA STATE OF FLORIDA
COUNTY OFNTY OF
The forgoing instrIAment was acknowledge before me The forgoing'instrument was acknowledged before me
thisday of 20n by this day of 20_ by
NI(C&A 11CA1 AASS oek
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific Type of Identification
Produced - L h Produced
A A LLD—
(Signature of K EN (Signatureof•Notary Public-State-of Florida-)
'0w,n
1Pay PLB i
�=o tate of Florida-Notary Public
Commission *_ Commission #G(GEWY484 Commission No. (Seal)
011 ' My commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS' V;EGETATION. SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2-17119