HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: ► 23 -1 Permit Number:
RECEIVED
'
-- - Building Permit Applicatio OCT 2 3 2019
Planning and Development Services rsT. Lucie County, Permitting
Building and Code Regulation Division j
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: J' �f� Tr4U_e.1C1fS W-1o4 r-F Parc..-e_
Property Tax ID#: Nl3- rjb3 ` C:�,I`a%- 00C) -<b� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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:� 3060 Sq. Ft.of First Floor:
Cost of Construction:$ tt7 ( l� � � Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �^ 4,{Z Name:' [dr, r s
Address:. 9 M, 62enn& Vie_ Company: Al o.%
City: b an NjzR State:(V\ Address: 673 SC3 Qen-"
Zip Code: Fax: � � City:'at¢ 5-( )vCc-f— State:
Phone No. Zip Code: 3$OA-7 Fax:
E-Mail: Phone No--)7g 466 9SGSr
Fill in fee simple Title Holder on next page(if different E-Mail r% e
from the Owner listed above) State or County License &t 6 L`ia
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:
FEE SIMPLE TITLEHOLDER: _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,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
W OUR LENDER OR ANATTORNEY BEFORE RECORDING YOU TICS OF COMMENCEMENT.-
Signature
OM ENCEMENT.-Signature of Owner/Lessee/Conr-as Agent for Owner Signature of Contractor/License
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF (2,(E COUNTY OF
The fo oing instr e t as acknowledge efore me The forgoing instru n s acknowledge efore me
this day of 20_N by thisday of 20_0 by
Name of person making statement. I
/ Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification.ICE—
Type of Identific on Type of Identi ation
Produced Produced 1 (_
(Signature o (Signature of N ul lic-State of Florida)
�Pa4a�% KAREN S. NIELSEN ""'�� KAREN S. �
`o ° :�`ayr�i 1 �EN
Commission �? ;State of Florida-No ggb ublic Commission No. .�`P �A �i
_. _ _ f Florida• o
ion # G 20 464 ary Public
My Commission Expires ;� `= Commission # GG 207464
i Y,F,pFF1O`` '��f' pPO�` M co
June 12, 202
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