HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: c I (D ' I�I Permit Number:
o ;
EcEIVED
Building Permit Applicat on DEC 10.2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County,Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 �
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential --�
PERMIT TYPE:
'PROPOSED 1'MPR0VEIVIENT.L0CATION
Address: 2ZoCA lin (pc-
Property Tax ID#: «3�- �U`2= CY`�Ll L{—�`�,-� Lot No. o2V3
Site Plan Name: Block No.
Project Name:
F'DETAILED,DESCRIPTIONTOF WORK-;,`
le PNQs6
CONSTR ,CTION INFORIVIATION .. . :
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:$ Utilities: —Sewer —Septic Building Height:
�OWNERAESSEE. CONTRACTOR:'
Name Name: A�r�i�
Address: Company:—C 61
v
City: 4i-_ �D State:_F:( Address: Zi,,-)5
Zip Code: Fax: City: 41c�-rr State:--E-k-
Phone No. SCo(--3—)1— 53 3 Cc, Zip Code: 3L(c) L('S- Fax:
E-Mail: Phone No 1-)2-919— 133
Fill in fee simple Title Holder on next page(if different E-Mail -1 cQn&c,-_icxsL:,c- kc 0 �r�r.•� },(�
from the Owner listed above) State or County License C-(S 7 6L(3
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 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."
1 �
Signa re of Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA L
COUNTY OF l,//�/� COUNTY OF ,J1 �6r�lz
The for oing Inst ent was acknowledged before me The for oing instra ent was acknowledge before me
this=day of 20� by this 0 day of 2Q1- by
J1q1<OAl ���f l i vet ��9 laJ �!f/%a 5
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type,of Jdentific Type of Identification
Produced Produced
(Signatu a of Nota Public-State of Florida) (Signatur
KAREN S. NIELSEN
Commission , �,,, KAREN S. U�y�Fublic Commissl r o UB`�'sState of Florida-Notary
( I IjF
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state oFlorida- o =_ *; Commission # GG 20 g'Q4
Commission #GG 2074e84 q, P; My Commission Expires
June 12. 2023
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