HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: ��0 ��?ri�
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•
REEVED
Building Permit Application MAR 3 0 2020
Planning and Development Services
Building and Code Regulation Division KrnIt&g,.Departme14
2300 Virginia Avenue,Fort Pierce FL 34982 p, cle County
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IM�RAOVEMENT LOCATION
Address: Iv Lc� e_C�Lca'
Property Tax ID#: Jr(�•- 50 C?^ 0(3'� O -- ®1'S O ^ Lot No.
Site Plan Name: Block No.
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Project Name:
DETAILED DESCRIP,TION'OF M K
e2 x .11 ��c.-1 021/ Aa e a G 6' A ci--)— A �•c Li I
CS ��o /moi (I~Te-r ' c3 v !" v
:"CONSTRUCTION fNFORMATI"ON
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
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Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ �OO Utilities: —Sewer —Septic Building Height:
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OWNER/LE5SEE . CONTRACTOR:
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Name 14,1
c C_ a Name:
Address: QiGcl Nic- S-(-c)Cey Company:
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City: "JAN evJ 96LState:rC- Address:
Zip Code: 30 Fax: City: State:
Phone No.<c, ( 3y9 L( Zip Code: Fax:
E-Mail: ! I_CD t,,at,.6c.. Ctcw1 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEM:ENTAL-7 STRUCTION.LIEN:;LAW INFORMATION
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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: I
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 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 approveI d 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 I
"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."
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gnature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFS �XA�e COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 'Nay of� 20 y this_day of 20_ by
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Name of person making statement. Name of person making statement.
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Personally Known ORIProduced Identificationfl 01— Personally Known OR Produced Identification
Type of Identification ' Type of Identification
Produced F L o c_ Produced
ELLEN VADJGHN ,m M
(Signature of otary Pub -State of Florid Commission # Notary Public-State of FloridaMy CommissioCc rp b' 4Vo. ELLEN VAUGHN (S October z2, o. (Seal)
ca° '%State of F ori a- otary PUblI
s• �< Commission #JGG 270079
s11'1"I.T.M`1Mission Expires
®r 2J hi SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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