HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ` c� to V ✓�
s
Building Permit Applicata n RECEIVED
Planning and Development Services
Building and Code Regulation Division OCT 2 3 2019
2300 Virginia Avenue,Fort Pierce FL 34982 ST, ucie q9unty, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resid
PERMIT TYPE:
PRO,P,;OSED GIVIPROVEMENT LOCATIQN
Address: !P 21
Property Tax ID#:1,606—:.500.. OaS 9- 0 DO 9' Lot No.
Site Plan Name: Block No.
Project Name:
ZETAIL€D DESMOT6 _' OF WORK ` ` .
1�46 PEYMILL 1410.0,6 1
CONSTRUCTION IN'F,ORNiATION:
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:$ -)0 Utilities: —Sewer —Septic Building Height:
gWNE4R/LESSEE, CONTRACTOR: -
Name
Ac dyeA0.
7 /Lw.v Company.
City: StateA Address: gAig
Zip Code: �</9'S/ Fax: City: State:
Phone No. '2 9,9- /A'1-° ® 96 9 Zip Code: -31/9#5 Fax: 'f'6 a 77 7
E-Mail: Phone No 44/- a 77�
Fill in fee simple Title Holder on next page(if different E-MailM i�male- je LY e.4zie_-1_. eorn
from the Owner listed above) State or County License $?59
L
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.
DESIGNER/ENGINEER: Y Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _C Not Applicable BONDING COMPANY: XNot 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,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 E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBT INANCING, CONSULT
WITH YOUR LENDER R AN ATTORNEY BEFORE RECORDING YOUR NJP110E OF COMMENCEENT."
4111W�lu
SikKaf ure of Owner/L see/Contractor as Agent for Owner Signature o Contractor/License Holder
STATE OF FLORIDA �S/, // i STATE OF FLORIDA
COUNTY OF (��1�IZ-' COUNTY OF ff (e
The for ,oi instr nt was acknowled before me The f r instrume t, a acknowled ed fore me
this_'day of � 0 ei— 20� by this Y� day of�C77/��r ,20 3y
114 IpAr
PuNA-Et- hm�57 a
Name of person making statement. Name of person making statement.
Personally Known l,-,,`OR
/OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
LLa Z
(Signature of Notary Public-State of Florida A.PruG (Signature of Notary Public-State of Florida)
Commission No. "ba� �Q TARY pUBLIC Commission No.rF 9a 7�� A.Prue
STATE OW FLORIDA `1�bTARY PUBLIC
Comr*FF9M65 STATE O�FLORID
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TVMW EWMOMIX20 9
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.