HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dbte:' Permit NunXber_____d2la_
E
4'Fcz -I Eaa Dv
M08 I cationDEC 9 2019
Pe
c:
..........
Building Permit App t
Planning and Development Services Permitting Depart Tien
Building and Code Regulation Division St. LUCie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPbSED1MPROVEM ENT
Address: 1 Yl
Property Tax ID#.-. c4 jLot No. A
Site Plan NamJku 1'n )<4A I Block No.
Project Name:
-DETAILED DESCRIPTION OF
WORK.
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 0 C) Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE"., CONTRACTOR:
NameKQ_A1A,Y_-,k, Va q Name: Q-" ,t P 0_r�
Address-'-I qReOC'YU�1)v Company: ie,[-1. YY l,
Cit \ State Address:oz-S—T
f) r)
Zip Code:W�T (OOJ 0 Fax. City: Q St
__7-) 'd). t?JN ( � I : -
Phone No. Zip Code Fax:
E-Mail: Phone No Q
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Q_V-C-(Y';
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 CONSTRUCON LIEN'LAW-INFORMATION
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 ANJAUQRNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agen or wrier Signature of Contractor/License Holder
STATE OF FLORID ��� Q STATE OF COUNTY OF ORID
COUNTY OF
The fRrgoing instrum t was acknowledg��before me The fjKpoing instr ent as a cknowledglgefore me
this�day of C„ 20 by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known �// OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
f<-c-
A- -
UA %11 1&/ - __ &UJyVW0A-4 )yI VtJW lwjy I
(Signatur�J.2i P - t e f l i (Signature of t Public State of Florid
•., KARLEY MARIE GIESY-VARNEY ��•, "' KARLEYMARIEGIESY•VARNEY (Seal)
Commiss �: Notar Public-State ofFlorid�Se ) Co rlda NntanrPuhlir_CrafaofFhCommission#GG 099801 t�z, ",
= Commission#GG 099801
4, My Comm,Expires May 1,2021 My Comm.Expires May 1,2021
07wwvo,w no Sanded through Natio-I Notary Assn,
REVIEWS FRONT ZONING SUPERVISOR P I LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v.-27