HomeMy WebLinkAboutBuilding Permit Application Ati:+APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�j J )
Date: l�IlIlq Permit Numb • / I / .__--� �
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NOV 13 2019
....... T ------_.W LL--- — Building Permit Applic 3tion
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie C nty'"FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: ELECTIMAL
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Address: !'/0_3- E LEERLW A 4N, FZXT PI�EeCE_ F/
Property Tax ID#: 3'70q r06 X 16-GYJOLot No.
Site Plan Name: Block No.
Project Name:
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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: 5n 00 Utilities: _Sewer _Septic Building Height:
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Name �V)nl�`� l�diYild QLi�� Name: V►'!eS 1 G�
Address: /16;5- � L� �'X� �YI'� I Company: �.- r/ l I
City: � . PeYm State:/ Address: /0/0-1J. ill I
Zip Code: day 11( Fax: City: / State:A
Phone No. 72a- 331P-4*J1& Zip Code: �'Jgyj Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail irjnl&S 1`Y1Ci-f•UJO Q 601, &)M
from the Owner listed above) State or County License La /W0 1641
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.
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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 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."
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Sign atu o caner Lessee/Contractor as Agent for Owner Sign t e of Contractor/License Hold
STATE OF FLORIM – STATE OF FLORI
COUNTY OF COUNTY OF
The for oing instru ent was acknowledged-before me The fo oing instr ment was acknowledged before me
this�day of 2( 10 this day of ® 20M, by
)A/,Yn es {'�a_- Cc ),q, e e�� _ cel .
Name of person making statement. Name of person making statement.
Personally Known L "� OR Produced Identification Personally Known '-'— OR Produced Identification
Type of Identification Type of Identification
Produced Produced _
i
(Signature of N tary Public-State of Florida ) (Signature of Nota Public-State of Florida)
Yr��P�m' AUDREY( 10MPHREY I ;'�raY • AUDREYB� iREY
Commission No. ;a.• •�:: �e� Commission No. rj
:a_
MY COMMISSION It GG 300817 �: r COMMISSI G 300817
:-W :o EXPIRES:March 8,2023 =;;� EXPIRES: 6,?_023 Isi
;,.;
•',,oF,F;;.•, onded Thru Notary Pu is rce,rn erw�,,��� '•�,,,, .aen a ru otary u li Underyr�!ers
REVIEWS � Y' ��� U ERVTSOR PLANS V E G E 4ffO ,,,Sf1AR '17Ez IC%(AMUOVE
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 2/7/19