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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. - Permit Num a 7A RPM TM ry .
FEB 2020
Building Permit Appli *&totting Department
Planning and Development ServicesFL
Building and Code Regulation Division �t. LUCIe Co e
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: U)a4e Y-
PROPOSED IMPROVEME N IN LOCATIO
Address: ^� rn Ig F
Property Tax ID#: �� �r = '� 1� ©� ��� ©�D Lot No.
Site Plan Name: Block No.
Project Name:
DE AILED �EZ'S*RJ�PTIMN�R=a
S C C� �I'D it
OONSTRUCTION INFORMATION:
Additional work to be performed under,this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric "'lumbing —Sprinklers —Generator -Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
L�
Cost of Construction:$ � Utilities: —Sewer —Septic -Building Height:
OWNER/LESSEE: CONTRACTOR:
Name fnAV'V 7 A Name:
Address: 5 3 e- oVk Company: •�rai/`✓ �Zs
City oS C _ -_- - . . ._ . State: fC Address: /7...2=r°: -! -_- :c:yk' f'✓a: -
c�
Zip Code:zy5; i Fats, City: A Pti`:4 `State's
,
Phone No 3 2/� S� Zip Codg Fax. >
E-Mail: Phone No�' :7.-Z J7..a)(Sl
q•. . .. ............... -
Fill in fee simple Title Holder on next page(if different E-Mail
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.
SUHER, AL CON T #U.CTLON l_lIfN LAW LN ®RMAT�ON�
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 thepermit 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 COMMENC ENT MAY RESULT IN YOUR PAYING
TWICE rQR!/IMPROzEMENTS TO YOUR PROPERTY. A NOTICE OF COM ENGfMENT UST BE RECORDED AND
POSTED'fS111 T E 30B SITE BEFORE THE FIRST INSPECTION. IF YOU IENw T O AIN FINANCING, CONSULT
WITH,l`IJO, ND!! OR AN ATTORNEY BEFORE RECORDING YOUR NOT,CIVOF O, ENCEMENT."
,r
rt
Signat,re o Owner/Lessee/Contractor as Agent for Owner Signatur f Contractor/License Holder
STATE OF FLORID STAT OF FLOR
COUNTY OF COUNTY OF
The forgoing instrum nt was acknowledged before me The forgoing instru nt was acknowledged before me
this? day of 20.PV by this"_day of 20,`,,0by
4)F) 0
Name o person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ic0hfic
tion Type of Id fi ation
Produced Produced
4<;�.4- 4--
(Signature of otary Public-State f Flori ) (Signature of tary Public-State ofFlo ida)
Commissi ........ 11DRelD.HUMPCommission
W COMMISSION U GG 300817 .,. AUDREY B.EXPIR M"6,2023 htI1MPFlREY
•�''a"n°Q'••BoM 7ku `;' �:= IBES:Match @,2023
REVIEW ERVISOR PLANS EI®D4ded GROVE
COUNTER REVIEW REVIEW REVIEW VIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 2/7/19