HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CO y-QED FOR APPLICATION TO BE ACCEPTEL;, - -
Date: 1 9 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Address:
Building Permit Appl
1 4,� - CU-Y Lfn,
RECET ED
DEC 2 3 2019
(fie County, Permitting
Commercial Residential
Property Tax IDN:\ 419 540 -D131- 000
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
P,nrt06d ,G)1.A-1 9m MQ
150x IS6i
a
Lot No..z7
Block No. 4 (o
/ilet.AJ ✓yl&M( ko ' oUce�:5u-A�
CONSTRUCTION INFORMATION:
Additi nal work to be performed under this permit- check all that apply:
%Mechanical _ Gas Tank _ Gas Piping _ Shutters
�/ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 250 Sq. Ft. of First Floor:
Cost of Construction:Utilities: _Sewer _Septic
v/Windows/Doors
✓Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRA OR:
Name i (' Q, urn U..
Name: Q
'0 D�1
Address: [904 �2�1( �17clC�a LI fL�E! ��
Company: -de, ' echOol %-s
City: co n CL I�FF _� State: �L
Zip Code 4c7R7 Fax: Nd N b
Phone No. __K54 —,2, 04 —/ Z4-8
Adtlress
City: �CI r1SS�e ,` "` Stater
Zip Code, Fax:
Phone No^' b"a�2 /`f8'bz
E-Mail: C1C/rk7i(p-J\5C1.9_? QUn-A; O
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 5�c. D a'3 <�Vm
State or County License (,96
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. ,
SUPPLEMENTAGCONSTRUCTC. lEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Name: ' ''�
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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.
5t. 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
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."
ev.
Signatur of Owner/ Lessee/
ntractor as Agent for Owner
5ignatu a of Contractor/LicenZs older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
t_ I )�J i r
COUNTY OF
The f r inginst m was
�
acknowledge efore me
The fo�$oinginstrument was acknowledge before me
Lday � by
thisday of
, 20�by
this �� of 20�
Name of person making staf ment.
�
Name of person mg statement. "
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of ]den tlon�
Type of Identification /1
Produced
Produced
natur a �-gubliE{{i�
yublio-
(Signature of NotarCommission
"•""�� KAREN S. NIELSEP
5(b�tjf Floritla•Notary Pub
Commission No.
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My Commission
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