HomeMy WebLinkAboutBuilding permit app All.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED , 1)�
Date: 3-- I - z, C Permit Number: ' `�I—t .I
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Building Permit Applicatio
Planning and Development Services MAR 1 7 202Q
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST.. ie County, Permitting
Phone: (772)462-1553 Fax-'(772)462-1578 Commercial Residential
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PERMIT TYPE:
Q1/EMET OCA t
Address:.-,) S v
C g(a_ men ac9� 3
Property Tax ID#: �� 42 0� 2� °�/(./' Lot No.
Site Plan Name: ! Block No.
Project Name:
f TAII E,D DESS dPTfC+1N Q f1R+K
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ST UCTIa (IVI=QRM TION:
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: I �T Sq. Ft. of First Floor:
Cost of Construction:$ 2S , IU v Utilities: —Sewer —Septic Building Height:
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��tNER/i.EA�S'�� CONTRA£I QR: _
Name \ !, Name:
Addres It) Company: I
City: {'wap h C2 �C.G� State:t`'� Address:
Zip Code:�Z,) 1,6 Fax: City: State:.
Phone No. 4(;o yo Zip Code: Fax:.
E-Mail: }-rnQ s(D1_ Cky I ,ca P,�, Phone No
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.
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DESIGNER/ENGINEER: It 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 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,.perforin the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie CountyAmendments.
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-.
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature o 0 r/ ractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAA STATE OF FLORIDA
COUNTY OF 0J COUNTY OF
The f r ing instru ent wa acknowledged before me The forgoing instrument was acknowledged before me
this day ofv 204W by this ' day of 20_ by
1 t U,1. . 9 mtr".
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide tirL,ff',atio Type of Identification
Produced r Produced
(Sign tur (Signature of Notary Public-State of Flotida)
KAREN S. NIELSEN
IPF' B��i
Commissi rr o,State of Florida-Nota P blit
-. #GG 4 Commission No. (Seal)
My Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19