HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST.BEtOMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `a�1��- Permit Number:
RECEIVED
Building Permit Appli tiodUL 31 20.19
Planning and De velopment Services ST, LUCIe County, Permltting
Building and Code.Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ✓
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
R� 0 - r OCL O
Address: oq C4 W1 10&
Property Tax ID#: ) ." 5ba bd6�� - 0 86-^ Lot No.�D
Site Plan Name: Block No.
Project Name:
A LED ► R I
• s � �• FOR o
Additional work to be performed .under this permit–cheek all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator !.Roof Pitcli.
Total Sq. Ft of Construction:
S . Ft. of First Floor.
Cost of Construction:$ Utilities: Sewer Septic -Building Height:
Q R LESSEE CONT • R:
Name Vl. Y i S L Name:
Address: g1J f►, .S Cc T_ . Q.cC Company:
City: ^o r�- A,e-Y-C-C, State: FL Address:
Zip Code: Fax: City: State:
Phone No&`f _J 15 $S 5 Zip.Code: Fax:
E-Mail: '-e l- 'Phone No
Fill in fee simple Title Alder'= 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 Cammencement is required.
�M WIN We O N ST ION OMA I e
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 covenant's 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,peifo-iffm 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 O N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIQA STATE OF FLORIDA
COUNTY OF 'S Luc\� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3\ day of 20 1 by this day of 120 by
Glna. c
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification -
Produced Produced
(Signature of Notary bl'c- A�RIEGIVENs '.(Signature of Notary Public-State-of Florida-Y.,,
, !" ,. DEi Mid) SIGN#GG 02203
Commission No.� - MY 9 ,,mbll16.20� Commission No. Seal
Ex PubricUrder),dter>
+r. •?' BondadThNNotZq
eOF F��•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TUR•TL.E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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