HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMP R APPLICATION TO BE ACCEPTED
(� RECEIVED
Date: I �.• -1 ' � Permit Number:
DEC 0 9 2019
5r. Lucie County, Permitting RECEIVED
m
Building Permit Application �Er o
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Pern-ml". .-
2300 Virginia Avenue,Fort Pierce FL 34952
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential —
PERMIT TYPE:
IN 7S E
t ��x510
170
Address: I 'l k5 y
Property Tax ID#: 33 _27 - 00 06 000- t Lot No.
Site Plan Name: Block No.
Project Name:
",F '�'"aS��Ir +a� "c" - „a rrar,x^S as x
sir RM ��
Re C I k l W bigr
01-31 ,.r.:"c#�'# 's exa ' .` ,':�,'.+ :. ,'...:,�sc.KYM'
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
e
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 0 O Utilities: —Sewer —Septic Building Height:
�����f��`'�' r�"�G.. '# �'*'`�y,'� ,"'��,�fd"��. '+�..z5.��#��€,� gz�.�� '�� LJ .-°r�--: �Ys � �xm't a���.II�,�•%�" .�''T�,.+-.`_,�`c"�s�
Name �l1A1i4VLr� 1-S 14nn Name: C �i I
Address: -7 9 Z0 LI n KS WY Company: �Lt/t� eDOGr�tG tWC
City: pst State:FL Address: '.(®( SE 0410_ 4 61-KeS 4�
Zip Code: Fax: City: S L State:�L
Phone No. 3 f,{_2 7 L4 Q 07 73 Zip Code: 3 Z4?J Z Fax:
E-Mail: Phone No Z� 2 Z4 O "3? 3 61
Fill in fee simple Title Holder on next page(if different E-Mail `J--W(I4/C4Pml P-a Q Y4 00 CdUi
from the Owner listed above) State or County License C 4(_10l Zd
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.
S,UPPL MENTALsCONSTRUCTIQN LItN LAW (NFOftMAT10N x
:.,,.
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 NONCE OF COMMENCEMENT."
Signature of Owner essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA _
COUNTY OF L.4 1 1l ./F_ COUNTY OF
The f going instrument was acknowledge efore me The f oing instr en as acknowledgVby
efore me
this day of 20_0 by this day of 20
A/7/77(' 04,f (33LFS iyge
me on mWrig_st6-t6ffiqfit. Name of person making statement. V r
/
Personally Known OR Produced Identification I/ Personally Known OR Produced Identification Y
Type of]dent' ' n Type of Identification
Produced Produced
( ]gnatu of o r P bl'c- tate of Iorida I (Signature of Nota 1 ,PuU�B;,StatIELSEN
� KAREN S. NIEL EN ��-State of Florida-Notary Public
a1P�e%, -* Commissio 207484
Commissi ri S t f FI i a-Notar )ic Commission No. - p- qq ecd�j
°• Commission # GG 207484 %,��oFF�o;, y Commi'sion Expires
My Commission Expires "'1110June 12, 2022
o
Juno-12, 2022 W
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19