HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1 Permit Number:
RECEIVED
Building Permit Applicati n DEC 1 7 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie Cou ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address: 2 0 ✓ P�
Property Tax ID#: A43.7 "eO - ODO 411 "0 00-1 Lot No.
Site Plan Name: P-% t C�Pt S j Y'K03 I L{_}4[?m Qi Block No.
Project Name:
i+M-19'-A e- Yn
IMP 91"-
N INFORMATION:
Additional work to be performed under this permit-check all that apply:
echanical _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: $ -2 Utilities: —Sewer _Septic Building Height:
lar-Name C 03P w. Name: C Jw& �rw CT'"9•
Address: �OOo �"w t,�k 7W QL Company: 1- . p,y `fir Q Lc ZTin4� c
City: �� LJ-W LJejF 1 - Cs State:f, Address: I Dojo CT
Zip Code: 33 �? Fax: City: W& N1u.Cfi1' - State: Ff
Phone No. Zip Code: 3 CLf iC Fax:
E-Mail: Phone No CL4l - A4 41'41't 17
Fill in fee simple Title Holder on next page ( if different E-Mail ". br `
from the Owner listed above) State or County License ejel / 6!2 2
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 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 Y UR LENDER QR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contrac /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing ins ment was acknowledge before me The for ng instru nt was acknowledged efore me
this day of 20 by this day of 20by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of Identifi ' n Type of Identification
Produced_ Produced
CZ1
0�11 1'4 LU_� -
(Signature of :1—-;_4 (Signat
KAREN S. NIELSEN ;%Oyd"/,,, KAREN S. NIELSEN -
Commission °`� ���;Stafe of Florida-t�g�yf Public Commis 'q �f State of Florida-Notary Pwwp�blic
ommission # G 20074$4, GG 20 PM
My Commission Expires ��yJfO _04 My Commission Expires
oFFjune 12, 2022 " June 12 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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