HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i� 1� 7.� Permit Number: � � �
REM
4 111 C r ..a
� r
Building Permit Application FEB 12 2020
Planning and Development Services Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. LUCI 'o LI nty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resl en la
PERMITTYPE:
Address:_ Co PikPA%%[A i�
PropertyTaxlD#: G, 9 — Lot No.
Site Plan Name: Block No.
Project Name:
N I®
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
— P
Total Sq. Ft of Construction: /570 n Sq. Ft. of First Floor:
Cost of Construction:$ 3 Utilities: —Sewer _Septic Building Height:
• p ;
Name�H) /�� f � Name: T�S�F. c1Z� Z
Address: c�(�Q�S... 1 ,� IG1 �'Gf� Company FaRh�lal. ..,h:ii� M9AIGL AC- L
City: � `R:1 "`�` � i Address j.
State:
Zip Code; . Fax City: State: 1
�� rtr !f
Phone No;..��+ J: `J'�. J:.� Zip Code '3 h Fa.x ,
;x
E-Mail: Phone No 7 .Z 2 'O
Fill in fee simple Title Holder on next page( if different E-Mail o 4 i `I
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.
SUPPLEMENT CONSTRUCTION I R13 !AW NFO NATION.
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
POSVD ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH OUR LENDER OR AN ATTORNEY BEFORE RECO DINC. YOUR NOTICE hF COMMENCEMENT."
\XA-
Signature%FL
er/Less e/Cot ctor as Agent for Owner Sign ur o Contractor/Li se Holder
STATE ORIDA STAT FLORIDA
COUNTY OF COUNTY OF
The forgoing instrum nt was acknowledged before me The forgoing inst was acknowledged before me
this )qday of 2aa by this 1�day oftru L 20.Z,by
Name of person making statement. Name of person making statement.
Personallyown OR Produced Identification / Personally Known OR Produced Identification
Type of Id ti •a i, n Type Identifi i n
Produced Produced
(Signature of No Pub' - (Signature of
Y AUDREY B.HUMPHREY ii.... AUD
., 817 REY B.HUMP
Commission No. = COMMIS�i �G�
Commission N :+: ,= My COMMISSION# 17
EXPIRES:March 6,2023 t ; '�`= EXPIRES.
3iEo�. d TMu Notary PubUc Undennllore 'F�*Flo`: Don4M Th March 6,2023
N NO
REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19