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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �� o/-� 1"/_ Permit Number: CE-111,7c- D - - NOV 2 5 2019 Building Permit Application Planning and Development Services Permitting Department Building and Code Regulation Division jt, LUCK County, FL 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT TYPE: n d 0 h LL Address: PropertyTax ID#: `L�-�`Lfl — go2 — ip© -31 — 0 — ,� Lot No. Site Plan Name: Block No. Project Name: SGQ n /z- im a e S o i - Its Additional work to be performed under this permit-check all that apply: _Mechanical —G asTank _Gas Piping zhutters -Lz17(lindows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 0Q 4 0 Utilities: _Sewer _Septic Building Height: Name c� C',� K��/�f�� Name: tC' Address: ��� [ S �� S�-r Company: d- L City:_ �ie�c,� State:-at„ Address: I"?' ASI •0:.: . Zip Code:' C:5-d�gy Fax:: - City:_ " 6' Cies: State: Gt . Phone No. Zip Code: Fax:?�.�- E-Mail: Phone No -l�(Z- Fill in fee simple Title Holder on next page ( if different E-Mail K2Lejaf STGA 2 66)4 - Gvo-1 from the Owner listed above) State or County License e°e, 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. SUPPL MENT LO R O CORM TION103: 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 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Owner/Levee/Contractor as Agent for Owner Signafure of Contrac r/License Holder STATE OF FLORIDA STATE OF FLORID COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this��day of �� 6'-V ' 20& by thi5::2�day of17V 1-"1/• 204 by �? 40 le ���f� j,STIL tic- Name of person making statement. Name of person making statement. Personally Know OR Produced Identification Personally Known OR Produced Identification Type of Ide i i tion Type of(dent• i n Produced Produced 1A 14 W (Signature o of (Signature o No Public-State of Flori a ) AU1 Commission O?° ""__ MYCOMMISSIONI#GG300817 AUDREYB.HU��IPHREY ( eal) E S:March ii � Com iso# ` ; Pub!ic Underr Tilers '�i ;i: :*: MY CO G 300817 ''.'FOF c�°` BondedThru Notary, EXPIRES:March 6,2023 — Ea r F F�• Bonded Thru Nota Public Un envn ers j;; REVIEWS FRONT ZONING SUPERVISOR PLANS'" VffffMTffff1r EA'TU RTC MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. i