HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 44 J q Permit Numb r•
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° J DEC - 9 2019
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y Building Permit AppliCinlnitting 1e ; rtment
Planning and Development Services , Lucie E CO U n 1=L
Building and Code Regulation Division yr
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT TYPE:
PROP.,OS11EID.:IIVIP,.ROVEMEN7 LQ.CATION
Address: y N161 ( -
Property Tax ID#: 34021
- lV 0,5- 00 000 2— Lot No.
Site Plan Name: Block No.
Project Name:
DETAILEDDESCRIPTION OF WORK
,.a
- - in
NST
RU INFORMATION �h
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric X Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: �1 Sq.Ft.of First Floor:
Cost of Construction:$ (BOO . Oy Utilities: —Sewer ,C Septic Building Height:
01NNE.R,/LESSEE '' CONTRACTOR
Name A Name:
Address: IY� Company:
City: State-9, Address:
Zip Code: _,-_�L4q$Z2_ Fax: City: �r� Stater
/
Phone No. Z- - L- �7 qZip Code: 62 Fax: Ill-5gf5-q ICI
E-Mail: Phone No 59 J- C1 loi
Fill in fee simple Title Holder on next page(if different E-Mail MQ n000,4f Y*@ fD/0te.lrQirlf ,c m
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION b rr
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 NOTICE OF COMMENCEMENT."
Signa ur of Owner/Lessee/Contractor as Agent for Owner Signb u of Contractor/License Holder
STATE OF FLORIDASTAT OF FLORi
COUNTY OF_: Jr Lurk- COUNTY OF
The for mg inst t,�( c nowledg before me The g Inst cknowI doe before me .
this May of MAW 20"M by this� y of � 20 by
►f►fd
Name of per on making statement. Name of person rdaking statement.
Personally Known ( OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 7"uced
b,Hpa C
(Signature of N t//a���ry Public-State of,Florida) (Signature of Nota Public-State of Florida)
Commission No..w 35 mission No � �
rr,, AUBREY NICHOLE HARTF 16>SD l� �3C)z�Uq (Seal)
Pue/�j;Notary Public-State of FI ride
52 49
`Q My Commission Ex IreS �NYpr, AUBRE NICHOLE HAR�TFFoO id
REVIEWS FRONT G Slsli�IV S VEGETATION NtbEerY �NAC)M! � 5
COUNTER REVIEW REVIEW co211
'r 'ss tt 1% s
DATE ` `
��nrir���� July 04, 2023
RECEIVED
DATE
COMPLETED
Rev. 7 1