HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�;(7� Permit Number:
• _:. CC,I 181019
_ Building Permit Application oepa��nent
perm`rt
Planning and Development Services St.LUcie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE: ' Re Roo
PROPOSED IMPROVEMENT LOCATION:
Address: 0 'eIC16LM Am 6-4
PropertyTax ID#: If(Q y Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
e Quo K 0 -V Wal ecl I lthl<
Mal A10 "7911..2— 14-U&11•n
FC6—NSTRUCT'16N INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows( oors
Electric _Plumbing _Sprinklers _Generator Roof S/2 Pitch
Total Sq. Ft of Construction:)l 56 Sq. Ft.of First Floor:
00
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
.OWNER/LESSEE: CONTRACTOR: ,
Name OWES I Mel k9_ UC, Name:
Address: S M5 Deea Ron QR Company '(.61 RMQ-
City:F6r-k Prerce State: Address: 39-z, lb�h PI Sld
Zip Code: 3WT5( Fax: City:�e,CO ha7gn State:
Phone No. Zip Code: Fax:
E-Mail t� PI Phone No
Fill in fee simple Title Holder on Wext page(if different E-Mail m
from the Owner listed above) State or County License gc-c2 n 51 Cy
�C>$a
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.
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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 thepermit 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 PAYING
TWICE FOR 1110ROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED=ONJ SITE BEFORE THE FIRST INSPECTION. IF YO INTEND T TAIN FINANCING, CONSULT-
W O A ORNEY BEFORE RECORDING YQIJPAOTJM OrWMM"CEMENT."
hignifureof ne essee/Contractor as Agent for Owner gigrature of Cont actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
��
COUNTY OF i— COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-�j_day of 20_0 by this(may of 0 C .20- by
Ah c_h QA sU 'J;
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced 0 Produced ��
(Sint e f a - ) (Signature of Notary Public-State of Florida)
ELLEN VAUGHN , ,
Co �I12;ate of Florida-Notary Publi al) Commission No. .``a�YPo'% ELLEN(ft HN
+ *= Commission#GG 270079 __ �: tate of Florida-Notary Public
My Commission Expires =y Commission # GG 2700
�nnnOctober o,,,o������.� ommissio Expires
R NO ING SUPERVISOR PLANS VEG r 2' WE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19