HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 D Z 2(P)q Permit Number: )n
RECEIVED
Building Permit Applicati n OCT o 2 Zoos
Planning and Development Services ST. 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
PERMITTYPE:
PROPOSED UM'PROVEMENT LOCATION;
Address:_ 2 Sa nell��'h� G�� P54 L 3 q Z
Property Tax ID#:� �n I (11sal one , I Lot No..
Site Plan Name: Block No.
Project Name:
DETAILED DEUSC*R+IPTION @F WOR+K; //
iv+5 4111 HeLy �cJ dal �leeZr %C in/�Ter heG1 AS'iyC ri gJ!I
CONSTR',UCTillN INPOR�MATION:
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:$ 700 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: 0C30TRACTQR:
Name Gu y Ga-w,a C_ Name: l4/c,u5-'y RAS�;JJ
Address: 22 ,4'6- -. a nilgi o c :i_y":. Company:
City: PSL State: FL Address: 6 w /vr, r `(W)
Zip Code: 3 4 0 2 2- Fax: City: S L. `State: J=Z-
Phone No. - _Q y 3OZ/ 62 6 7 Zip Code:
E-MailA_,,ct Cz 3 �>'e n e Phone No -z-7 2 �/i0 73 6
Fill in fee imple Title Holder on next page(if different E-Mail col-Y)
from the Owner listed above) State or C unty License 'CE Jai R 3 9
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 ONDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE-70117 COMMENCEMENT."
Signature . ner ssee/Contractor as Agent for Owner Signature olac[tro cense Holder
STATE OF FLORIDA / STATE OF
COUNTY OF �L(I(,�J� COUNTY OF
The f oinginstru t vas acknowledge before me The for oing instru t w s acknowledge before me
this-/, day of 1 204 by this / day c 20 by
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Name of pers n maKing statement. Name of person maki g statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ' n Type of Identification
Produced kL fProduced
17Y IA
(Sig a re SEN (Signature o
tPBYPt, KAREN S. NIE SEN
„���,,,
;_° ��;State of Florida Notary Public ;:o�YPos% q�a � bli
Commission _ ion # G(6�h484 Commission '�° ` :State of Fsood# GG 4,64840
9.F o° My Commission Expires =9 ac'
"'o � June 12, 2022 '',7;oFF���,`, My Commission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Aev. 2/7/19