HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tI
Date: (0 '( 1 Permit Number: \ IS
Building Permit ApplicatLRETCEIVED
Planning and Development Services
Building and Code Regulation Division C 1 6 2019
2300 Virginia Avenue,Fort Pierce FL 34982 e C�af�y, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATIO :
,..
Address: (C=01 . `FP
Property Tax I D#: 0 Lot No.
Site;Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Li
FONSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator V Roof Pitch
Total Sq. Ft of Construction:
/C): � Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:_YA.%INQ 1,_),
Company:
Address: 666 -Pe+ ` > '1�n.e.
City: �'k �reyr,� State: r-1 Address: fii'13 .t9cj
,�0 QeAe (✓ LSA
Zip Code:S-kFI9Z Fax: City: W-F sA 10cState
Phone No. Zip Code: 17 15_� Fax:
.E-Mail: Phone No`7')a o` b-0
Fill in fee simple Title Holder on next page(if different E-Mail L.5",
from the Owner listed above) State or County License 0_fL 3 A II—o
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 PAYIN&
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
WK YOUR LENDER OR AN AJIORNEY BEFORE RECORDING OUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Coatfactor as Agent for Owner Signature of Contractor/Licea older
STATE OF FLORIDA t 1� STATE OF FLORIDA
COUNTY OF ,�� COUNTY OF
The forgoing instr e tIts acknowledge efore me The fo going instru t s acknowledge efore'me
this ►fin day of 20 by this day of 20L4 by .
1 _1qua.
mn,
Name of person making statement. I Name of person making statement.
Personally Known OR Produced Identification I✓ Personally Known OR Produced Identification
Type of Identifi o Type of Identificatio-n
Produced Produced
(Signature of lic-I&Ador SEN (Signature of Nota
:State of Florida-Notary Public ";r P, KAREN S. NIELSEN
Commission N ac Commission # 7484 Commission No. �2°tom P,
'y
of Flor{ol � tary Public
1FF mmissidn Ex�ires - - mmission #G� 207484
" � June 12, 2022 P M 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
ev.