HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,. 19 Permit Number:
FR "V'7r
2 2 ';'9Building Permit Applicatiounty, 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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: ` 7�a & ,eq// ��11 CC (.f __f?_►�1�} /�
Property Tax ID#: 3 a5— o 0/ Lot No. �
Site Plan Name: Block No._
Project Name:
DETAILED DE�SC�RLPTION (�7FWORK:
A-e-,-AAq If
41
�' - A- c ,e
CONST, ION 1!NFORMA.TION:
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:$ ��� �� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: // CONTRACTOR:
Name t�1�"� I T iz l� Name: � N b
Addcess:?Z? �. _ LU AA 'I '�r�c�i9- C1'if Company: --1210 D � �
,City fJ(L't'.ST-. L-�(G�� Stater Address:Zq�-3-> _�X+-JAe�--JC A-/UG
Zip Codd-e,:^� Fax: City: blZ-�' ST": LGLCr/`5- -State: L
Phoned?`.3... d 19d5 Zip Code:; .dl Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail A-1 oex-� 234044)44� ,V-6 7
from the Owner listed above) State or County License---e 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.
1
SUPPLEMENTAL CONSTRllCTION LIEN LAW INFORMATION:
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 Associatioh'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 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 ontrac r a Agent for Owner Signature of Contractor/License Hol er
i
STATE OF FLORIDA STATE OF FLORIDA i
COUNTY OF e . I. ��L��, COUNTY OF
The forgoing instr e tJas acknowledge] before me The tcpying instr n s acknowledge before me
this clay of 20 by this�Lday of 204 by
mei %Ln fwIJK _�ELAjo
Name of person making statement. / Name of person making statement. /
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification !/
Type of Identif' ' n Type of Identific .
Produced Produced
- _—�
(Signature of Notary Public-State of Florida) (Signature of Not P.
"Yd's,, KAREN S. NIELSEN
Commissio NRr������,,; VAQr:K S NI Commission No. =°tom GState of �I@c� a Notary Public
�.P N = Commi sion #`GG 207484
_State of Florida-Notary Public
My Commission Expires
_. Y_ Commi
ssinn it%rF aS I"inn 12, 2022-
My Commission Expir s
REVIEW L^Zoftll4G2 ' 'SU RVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUN VIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED,
DATE
COMPLETED
ev. 2/7/19