HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (1,
Date: I b • I,• Permit Number:
REC IV9-D
OCT 17 2019
BuildingPermit A nlicat
- - pr 'nS'in
' Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial =Residential
PERMITTYPE:
PROPOSED I PROUEM N LOCATIO .
Address: aao Rn Am)o Oin�'�g
Property Tax ID#: 3�q• �� 2�t_�� / Lot No.
Site Plan Name: Block No.
Project Name: ��
m7am DOC«RFPTION OF WORK:
P z
CNN6TRUCTION I MR1FOR++NATION:
Additional work to,be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Dpors .
_Electric _Plumbing _Sprinklers —Generator _.Roof Pitch.
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
I
Cost of Construction:$ �d� Utilities: —Sewer —Septic Building Height:
O N R L�SSE CON MiRACT R:
Name poull oundjcw- ll0 17 rumoll Name;- SAM �
Address: a a0i(l!/ I P, ►�lfAfl� Company::
City: P Sl. State: Address: +
Zip Code: ,Fax:,Fax: City: 'St'ate:
Phone No. ��o�- 333- 73x3 Zip Code: Fax:, --
E-Mail: 1P RCA�Lk @ `(Hho - Ozm 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.
KoftPP 19 ME1XNA111,E MEN MARTO
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',jn 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."
Signature Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 4. ,Luca/t.. COUNTY OF
The for Ing instru t acknowledged fore me The forgoing instrument was acknowledged before me
this day of 20by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known V/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign fur (Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
1P VB i
Commissi ' . `:State of jlorin #GGfg%b1ic Commission No. _ (Seal)
-UmillioP My Commission Expires
1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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