HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � ��� Permit.Number: 2.,
Building Permit Applicati n DEC 0 3 2019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce rFL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPR01/EMENT LOCATJtUN:
Address: 965 >rGS.AJO W ,f?� 1,1&Q 3-1(f113
PropertyTaxlD#: Lot No.
Site Plan Name: �T'� '! Block No.
Project Name: AML01W
DE A4LED DE=�5� IPTtON OF WORK:
`iFLa- " x7
CONSTRUCTION INFORMATION:
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 I ".,Pitch,
Total Sq. Ft of Construction: s Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
O N =R/LESSEE: CONTRACTOR:
Name 0HIOA-tA Name: Ad4-,&A 'L
Address: Lam..' . .''. .1616-__.y Company: dAZw1 J s�ocat
City: did` "1T. �tx* .t -Stade: ie-4 Address:
Zip Code: Fax: ` City: State:
Phone No. HT1:; ,1�'$'.4s� - Zip Code: 3Z-4 ''Fax:E-Mail: Phone
PhoneNo :;. -
Fill in fee simple Title Holder on next page(if different E-Mail A.AJ- 7 & S6r1rf
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.
SUPPLEME TAL CONSTRUCTION Ll'EN LAW fNF RM TION:
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;'pe'rform 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 no 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 LEND 'OR- ATTORNEY•BEFORE RECORDING YOUR NOTICE OF COM CEMENTV`
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��TU0, COUNTY OFA I!UC,f
The f going inst ument was acknowledge efore me The f going instr e t was acknowledged before me
this day of 20-LI this; day of 2011 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification
Type of Identifi�,�n Type of Identific on
Produced L Produced
(Signature.of Notary.'..Public-: tate of Florida.)- (Signatu -
' KAREN'S. LSEN ; ` .State of.•Florida-Notary Public
Commission N YP�a% ( ) Commis •° Commission # GG 2001)
fFlorida-Notary-Public M Commission Ex fifes
Commission # GG 207484 .,Foii;o, Y P
o: June 12, 2022
12, 20 2
REVIEWS ISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.