HomeMy WebLinkAboutBuilding Permit Application 1 -
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I �i
Date: 1 2,, U-�_q Permit Nbmber: ' O t 30
RECEIVED
Building Permit Applicati n DECO-62019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
A4ldress: �j A MC(' 1(,
PropertyTax ID#: CM C.o Lot No.
Site Plan Name: Cc C Block No.
Project Name: Lq K_C__ Y
L
Additional work to be performed under this permit—check all that apply:
—Mechanical, _Gas Tank _Gas Piping —Shutters . _ _Windows/Doors
_Electric Plumbing I _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: &co3 Sq. Ft.of First Floor:
Q9- -;
Cost of Construction:$ 6 6 Utilities: _Sewer _Septic Building Height:_
Name a �' i rs e Name: `g y r
Address??: lt % VEL 6 CL, Company: C4K-�r
City: C v- - State: Address: 3 G /c--
Zip
cZip Code: l r( Fax: City: z State: [
Phone No. C 3 ��a-�' 7 �� Zip Code:�3 (f iY:'� Fax: '72-'t(e'� P�
E-Mail: / 1 Phone No�Q:L --q&(-'x�3 w l�
Fill in fee simple Title Holder on next page(if different. E-Mail Y` e e _
from the Owner listed above) State or Cou 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,
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 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,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
WOW YOUR LENDER OR
AN ATTORNEY BEFORE RECORDING Y401JR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as'Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ' STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing inst ent was acknowledged efore me The f rgoing inst ment was acknowledged efore me
this�day of_��- .2Q��by this day of 20 by
F0_416c�_, IiPt+ Y
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known ✓stOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Si a re o (Signatur eAaibli�tt
otPw�P�a,, KAREN S. NIELSEN Pga, KAREN S. NIELSEN
Commission State of Florida-Ns;VI�ublic Commissi r* ;State of Florida-Notary
Qc omm ssion #G 20 484 rc on #GG 207484
F�O��� My Commission Expires =.;��°F f�Oo�= My Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.Z1 1/19
K