HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST_BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q Permit Numbe XV-F-D
RE '-1– .nom
w NOV 18 2019
Building Permit Applic tion
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: ��
05E® 1MF'RU1fEMENT L+CAT10N ,
Address:
Property Tax ID#: �^ ��� ` '/` J' �V Lot No.
Site Plan Name: Block No.
Project Name:
o�T�:I`t��o oEs� IP ►o� o� a:R :
f 04Ku)1116; 6Da,,00 h 1J"L1
co sT ucTla�v .N oRMA �oN: ?° .
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: $�,j o00 ,� Utilities: —Sewer _Septic Building Height:
c® TM&M,
Name IZAA4 646-ic Name: ho,4J&0 15
Address. _?t i` „PXAJ,�1C6A 6�� Company:�;LGtl: z��/1.Ge
City: ��� Stated Address: F-.3�v
Zip Code: �Fr Fax: City: % State
Phone No. 8 �7� LZtio Zip Code: 2 Fax:
Z
E-Mail: Phone No J -7 7.2, '7i1- 535/
Fill in fee simple Title Holder on next page(if different E-Mailr5, f (2 LL 161. /,--i 1�j
from the Owner listed above) State or County License O4 604/68fl(f
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ��7
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. " I'
SUrPP, �aMEN A C®N�T'j�U TION I =' ° LAIN Nr'4�R ATI®,
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 OUR LENDER OR AN ATTORNEYyBEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign re of Owner Lessee/ ontractor aCAgent for Owner Signature o ntractor/License Ider
STATE OF FLORIDA STATE OF FLORIDA
COUNTY COUNTY OF
OF
The fgr ing instru e,nnt was acknowledge efore me
The fy ing instrument w s acknowledgWby efore me this / day of U 20 by
this ( D day of 20
Name of person making statement.
Name of person making statement.
/ Personally Known 11� OR Produced Identification
Personally Known OR Produced Identification Type of Identification Produced
Type of Identification
Produced - /�
0.
(Signature of NotA4 Public-State of Florida )
%ra ,lam
(Signature of Notary N blit-State of Florida ) Commission No.
lc�Y? '•: AUDREY B. EY
�1 HRAUDREY B.�IUMPHREY
Commission No. (�� MY COMMISSION##GG 300817
OMMISSIOr�f �G 300817 EXPIRES:March 6,2023
EXPIRES:March 6,2023
°F Bended 7hm�dotary Public Undervmters
Und Vis-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19