HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: k d 1 a5 1 N °\ Permit Number: I 1,4,
RECEIVED
. - OCT 2 5 ?_019
Building Permit,Applica ion
Planning and Development Services S7. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PRO •SED IMF'ROUEMENT LOCATION:
Address: //0/ zy a t G�ti
Property Tax ID#: r (� �(,3 O - 00() "'p Lot No. 19-
Site Plan Name: Block No. 18
Project Name: �� / 5 -@ �N Aor- d
M ETA LED DESC•aPTI • N OF WORK:
!'►'�d + T f4o rs^ +° °,QC,A4 S
CONSTRUCTION INFORMATLON.
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:
OW ERjLE�S�SEE. CONTRACTOR:
Name M;4 k ,,-1 � / S,P/Y1 Name: Dw4 ,e -Ir YlO S
Address: I' =( Eby Lam' Company' NZ/� cavT� os3:
Cit -F• �o`%'C Z State: ;Address:" -
Zip Code: Fax:•' City: (� �,�c..prC�e. • •� ._ State:
Phone No. Zip Code: Jam.y Fax:
E-Mail: Phone No 7`7a- a 11R. 9
Fill in fee simple Title Holder on next page(if different E-Mail /,O[ en:9ll II%rim C`:' 011 0
from the Owner listed above) State or County LicenseC('�0 f 5-1 VS X5,
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.
IIESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _'Not�Applicable
ame: Name:
ddress: 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 AFFIDAVIT: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
WITH YqUKTONDER ORAIM ATTORNEY BEFORE RECORDING YOUR NOT OF COMMEXff MENT."
Sig r=FLO
r/L s /Contractor as Agent for Owner Signature of Contr cto /License H er
STATEI STATEOF F A
COUNTYOF �'�'• �—y� �@ COUNTY
The for oing instrument was acknowledged before me The for instrument was acknowledged before me
this Ik'-) day of d c74v 120_11 by this day of C5c=k- 20—VI by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR.Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida S%S (Signature of Nota �- tate at Dj"VMEG
„�ap AA w— G 022023 _:q' = MY COMMISSION#GG 0 023
Commission No.GG�Z- �fl`Or 1SS10 20
N#G16,p b 201,
Commission No. EXPIRES:Dee �ndenetters
Y •� M Eg;DeCem_ Und'r*01ess +,E oer• sondedThniNotaFF9�'PPtt11YY�1
'* ME
mNNo1aN
REVIEWS FRONT G SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19