HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /q
Date: L-- Permit Number:
RECEMED
12019
Building Permit Application
Planning and Development Services permitting Ba artment
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 R
Phone: (772)462-1553 Fax:-(772)462-1578 Commercial Residential
PERMIT TYPE:
Address: 2(001 l abP-1 P17) F)ULT
Property Tax ID#: ( �--� t�``��-- 'l (�'� >�('�� �j Lot No.
Site Plan Name: Block No.
Project Name:
cT • -
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:.
M1111101111
Name C'cs ���� f�y 7Namme-
CoAddress: �1'60� _}k_-J_ J� 'eIV� - a
City: Stater 'Address;
Zip Code: �3�7g.�1 Fax: City: State:
Phone No. 914= Zip
E-Mail: >zl5Ght'"14sfawpllone No
rv
Fill in fee simple Title Holder on next age(if different E-Mail
from the Owner listed above) State or County License
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.
S PP MENT L �NSTRtJCTION LIE LA I�NF�RMAT4t�7N:
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 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 permitwill 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Age for Owner Signature of Contractor/License-Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF . L�1C,r, COUNTY OF
The for oing instrume t is acknowledge before me The forgoing instrument was acknowledged before me
this day of Q , 20 by this day of 20_ by
Name of person making state ent. I
/ Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identi#+e�atton Type of Identification
Produced Produced
t
(Signature of Nota P (Signature of Notary Public-State of Florida)
spar"P'�a,, KAREN S. NIELSEN
Commission No. State orfSF ',a-Notary Public Commission No. Seal
- = Com issi n # GG 207484
P My Commission Expires
12. 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19