HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I I! ! 19 Permit Num E;
_ _ 9
NOV - 8 2019
• 6
- BuildingPermitA I'c '
pp "ting Department
Planning and Development Services ��. Lucie CO U tl��/ �L
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: (5 e C r- 1 CGS
PROPOSED'.IMPROVEMENT LOCATION';
Address:
Property Tax ID#: 'Z-CA 0 3 - 6 Q Z- 0 02-9 60,) - 6 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK ,
-
- r e Ti c%&c I S d AMP /k&,e ef- 'W ealkU' P` a o-F 94A
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_('Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
J Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 7 i ZZ Utilities: —Sewer —Septic Building Height:
ONER/LESSE'E „ : '.CONTRACTOR.
VII
Name 'Z r- A k6_,e`fU1l Name: EN c
Address: `/G.S d w-n 7 Company: W ?/`cw ii-Z .11 G
Cit State: i=L Address: 3-5'0
U
Y _ en ,nei'` C
Zip Code: :,5„ ::., Fax: City: . ' ..,- ��J :`pICIYC r' 'State: rL
Phone No. Zip Code: 3 tk 9 LI 7 Fax:
E-Mail: Phone No '2 7Z -G(
Fill in fee simple Title Holder on next page(if different E-Mail V "`e A J4--Z -tA G a I (_6M
from the Owner listed above) State or County License LC, f 3 GCS J-J- f
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 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 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 N TICE OF CO MENCEMENT."
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/ icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instryjnent was acknowledged before me
this day of WV6116es ,20� by this I day of IV 17Vftbo" ,20 19 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
y
Nota Public State of Florida J ;,sr Notary Public State of Florida
(Signature of olk II`- O (Signature of Notdry Phi -$ta g
1 4.A Expires 02/2612022 185665 *?�. J E fres 02/26/2022 GyG 185665
Commission No. I Commission No. GG M,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19
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