HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) ,n
Date: Jr �'� I Permit Number ( 0.cys�
REcnkfEf)•
"'ED
- - Building Permit Applic tion
OCT 2 1 2019
Planning and Development Services Permittin
Building and Code Regulation Division 9 Repel-tMent
2300 Virginia Avenue,Fort Pierce FL 34982 fit• Lucie unt
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �� ��
PERMIT TYPE: RIC, rV e�
PROPOSED IMPROVEMENT LOCATION:
Address: C`6 Z /�' S JQ eta�,i 6JP.'t ��- 3Y
Property Tax ID#: 5t r I- 5qOQ(Q�- Lot No.
Site Plan Name: R Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
L S 1ti� it sa-w
kut
CONSTRUCTION INFORMATION:
Addal work to be performed under this permit-check all that apply:
:;�M�ee chanical _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: $ � ® Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ita fnex— Name:
Address: Company: WXIOA 0 �silC.
City: TtA m _&t'4 State)F-7(— � 5h/ f:
Zip Code: Fax:/yl�o/ City: R- Ldi4v _ State*��L-
Phone No. Zip Code:-"§UY%3 Fax:
E-Mail: 1',(JPhone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License CPrC-(3(g5'cG
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:
FEESIMPLE 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,wails,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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA JI STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledg before me The forgoing instrument was acknowledged before me
this"(day of L L`f . 20c( by this r7f day of 11-by
J
JQ n �1 e r— A
Na a of person making statement. Na of person making statement.
Personally Know OR Produced Identification Personally Known OR Produced Identification
Type of Identific-at Type of Identca
Produced ( C~ Produced
(4"'� ip
(Signature of Notary blic-State of Florida (Signature of Not Public-State of Florida
A R�;sea ��-pyaf��Aai
Commission No. ;sYP; AUDREYB U�N1 HREY svv�a gUDREYB. MP EY
G300817 Commission No. . � :'s.•• •••4�:
OMMISS����}' OMMISSIO 300817
2023 :
= EXPIRES:March 6, k " ' EXPIRES:March 6,2023
REVIEWS ZONING SUPERVISOR PLANS VEGETATION_��" SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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