HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��•"I-�:� Permit Number:
RECEIVE[
1 OCT 1 1 2019
Building Permit Application.
Planning and Development Services ST, Zycie 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: -A'e�(;�ACWL--
-0-bt4 1MPI�OVEIVIENT-LACATION,
c�' '"
Address:'- 93 4;3 . VI/44,4
Property Tax ID#: 0�-C]� (� - Lot No.�
Site Plan Name: Block No.
Project Name:
DETAIIE®`DESCRIPTION`OF IA/13RK::'
t ,pe�&'- - o)), ate.
717
CONSTRUCTION IlilFORMATIAN .F
a
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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:$ ���r Utilities: _Sewer _Septic Building Height:.
ip'WNER/LESSE COIVTRACTOfi�
.$.
Name /10 Name:
Address Company: bld ?z
City: State:_ Address:
Zip Code: Fax: City: State:
Phone No. 3[I S- Trp Code: Fax:
E-Mail: r Phone No qW 7 x u
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$7,500 or more,a RECORDED Notice of Commencement Is required.
v�;-
SUPPLEMENTAL CONSTRUCTION>LIEN LAWINFORMATION; }
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name: i Name:
Address: "Ad
City: State• City: State:
Zip: Phone Zip: Phone:
FEE SiMPLE TITLE HOLDER: ''Not Applicable BONDING COMPANY: Not Applicable
Name: ' Name:
Address: Address:
City: l City:
Zip: t2hone: Z ''Phone:
OWNER/CONTRACTOR AFFIDViT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is In conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-resldentlal use
"WARNMIG TO OWNBE YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYNG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SiTE BEFORE THE FIRST INSPECTION. F YOU INTEND TO OBTAIN FU MICING, CONSULT
WffH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signa a of Owner/Less ractor as Agent for Own S ature of ontra or/License Holder
STATE OF FLORSTATE OF FLORI
COUNTY OF COUNTY OF
The f oing instr nt vE s arknowledgg before me The going In ,�e$t,_ s acknowledge before me
this day of ZOl by this day ofu�-�— .28 L by
Name of person making statement. Name of person making statement
Personally KnownVOR Produced Identification Personally Known OR Produced Identification
Type of Identifica Type of Identification
Produced Produced
uAeo WuVM
i u ryubli a of Florida
ROBE T ETINGOFF b ROB TINGOFF
Commission No. A?i; jss]oN�GGi9923T Commission No. �p jq �CTINGl992F7
EXPIRES:Apd]30.2022 EXPIRES:AprH 30,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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