HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SAIL
rJ at a • MAR 1 8 2020Building Permit Applicatio
Planning and Development Services VRECEIVED
ie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: <::-,::—p�,� T
P • PO� �D I' PR011 M � T LOC TION.:
�
Address: ?0 lcl
o--�� C Cr -7/�
Property Tax ID#: h, ��- ` d /^ Cb b ) Lot No.
Site Plan Name:Jexlw Block No.
Project Name: &t'
�ETAlLED DE�CR,IPT ON fl WORK:
CON TRUCTt( NAlNFOR ATION:
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: ��``190 Sq. Ft. of First Floor:
Cost of Construction:$ 9- 5(D c9 C7 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE. CONTRACTOR:
Name CO3"'r v Ud J 4:e'r Name: '-IGJ� d"Jtt—
Address:.2 1 '? /-f'ep+ C 7' Company: ���
City: Address '�e✓�o� -� Li{`�
Zip Code F3 '° f2 �''gFaic t 6 City: '"Cly � c�'- `�=°�" '• t a :Statr
Phone NON �Y� I G�s a Zip Code �.°'�o10�z, Fax. �t
E-Mail: w�_..>_ -.-.a. : Phone N6-772
Fill in fee simple Title Holder on next page(if different E-Mail 1111. LOpkcpeie_' ft 3 C leer t 6c,
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.
�UPP E E TAL CO STRU M LICK W9 Riffammum.
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 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 LE ER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF MME EMENT."
Signature o Owner Lessee/Contractor as Agent for Owner Signature of Co actor License Holder
STATE OF FLORIDA - STATE OF FLORID
COUNTY OFCOUNTY OF
The fy�rgoing instrument was acknowledge before-me The foJ oing instrum nt was acknowledged before me
this/�/ day of � 2�y this /1 day of 2( =�y
Name of person making statement. Name of person making statement.
Personally Knowry / OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of No Public-State of Florida (Signature of Nota ublic-State of Florida)
Commission N :•�f��� %; AUDREY8-Jy REY 'yP" G
pp�l,,�l Commissio ;c�:"•"•••.•''=, AUDRE1fB.HUMP�` I
MMISSI a't G 300817 MISSION#G �7
$F EXPIRES:March 6,2023 =.: n•: EXPIRES:March 6,2023
• Public rs F F° Bonded Notary Public rs
REVIEWS FRONT ISOR PLANS NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
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