HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED' (�
Date: ` Permit Number:
RECEIVED
'Building Permit Applicatio DEC 17 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: .
R•
Address: � O �) tce er(e_
Property Tax ID#: � 9 ^ 5�.• VCJ� (�Q , Lot Na.
Site Plan Name: Block No.
Project Name: frfAr yah
ffgJ MDa2§CAR •
Q
Additional work to be performed under this permit-check all that apply:
Mechanical Gas Tank Gas,Piping _Shutters Windows/Doors
-
1
Electric —PlumLrg.' _:S:prinklers Generator _Roof, :Pitch
Total Sq. Ft of Construction: Sq.-Ft. of First Floor:.
Cost of Construction: $ q�� . Utilities: —Sewer _Septic Building Height:
Rj� ��• R
Name G 11vd. Name:
Address: fl/" < o` 1 Company:
City:_JY r l-c��1�`�,I.J '`' State:1 Address: Vol
Zip Code:3 t <°3 Fax: t City: 417f:`. State 'l
Phone No. - Zip Code: .:/` Fax. �t `7fl tSOur
E-Mail: Phone No ft)-- T9J-y dS- /
Fill in fee simple Title:Holder on next page(if'different E-Mail c i Q. e Goww
from the Owner listed above) State or County License_%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.
DESIGNER/ENGINEER: _Not Applicable M1111
ORTGAGE 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 clothe 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
/which
Please consult with your Home Owners Association and review your deed for any restrictions which.may apply.
Inconsideration of the granting of this requested permit, I do:hereby,agi-ee'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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 , STATE OF FLORIDA
COUNTY OF J�9 J �I�. COUNTY OF
The for oing inst ment was-acknowledge efore me The for ing instr ent was acknowledged efore me
this day of . 20 I by this day of 20 J by
("lu rio 0 lord
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification it./ Personally Known OR Produced Identification -�
Type of Identifi � Type of Identific
Produced- rtlProduced ' be -
4 A-1-.4 A CA 14 � ILI
(Signatur (Signature
;:RyP�a, KAREN S. NIELSEN ota�JP�a KAREN S. NIELSEN
Comm ;State of Florida-Notar P is
yy����u� 'O _State of Florida-Notar
# GG 2tT7-484 Commissio - tl)c.
=
Commission # GG 207484
%�9rF °ec My Commission Expires.1tinp 12 '2022 oQ My Commission Expires
%,SOF F;`�\
REVIEWS FRONT ZONING ` SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW' REVIEW REVIEW
DATE
RECEIVED.
DATE
COMPLETED
lev. 2/7/19