HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 O V
RECEIVED
a Building Permit Application
UUT' 16 2019
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
PERMIT TYPE:
PRQPOS�D JMPR01/EMENT LOCATPON:
Address: / C? �f 1,/ G w 16i �� S
Property Tax ID#:X71 66 J Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED 009R+IPTION OF WORK:
L
CONSTRUCTION � FORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric -Plumbing ;;:='Sp rinklers _Generator _-Rdof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OW�A@ CONTRA TO
Nali'l lL' Name:
Address: �, (o y fJ Ci":a S Company:) G11 Dv iS A/ li
City: State:_ Address: �,Lr�c S-A ��ir' = J: V J 'OL
Zip Code: ��.� Fax'.' City:
Phone No. Zip Code: / Fax:
E-Mail: Phone No 7 6jam�,,,,// L/_,,
Fill in fee simple Title Holder on next page (if different E-Mail GGG amu/ L 4� 4-M
from the Owner listed above) State or County License 4?U 36 5 66
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.
7Add
I L ME,NER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
: Name:
ss: 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 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 1-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."
A(,26,�
16C,4-
Signature of Owner/Lessee/Contr ctor as Agent fo wner Signature of Contractor/License Holder 1 '
STATE OF FLORIDA �I STATE OF FLORIDA
COUNTYOF jT_ J�l� COUNTY OF
The forgoing instr a as acknowlel before me The for ling instru t w s acknowledged efore me
this day of 2, by this day of 21 by
Name of person making statement. J
/ Name of person making statement. J
/
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification-V
-
Type of(dent' ion Type of Identifi n ''\\
Produced � � _ Produced U
(Signat'1I of Notary Public-State of Florida) (Signature of Notar Pulb'lti State of Florida)
Commissi n�( P''% KAREN S. NIEL ` �``'Yd''�, KAREN S. NI ON
Commission N oo�P" �8�--
;_� �; a e o ori a Notar u is n--tate e �lorida-No ublic
E. *_ Commission # GG 207484 'c Commission # GG 207484
?� k A. ?9 a:
June 12, 2022 '"""'" June 12, 2022
REVIE UPERVISOR PLANS V GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19