HomeMy WebLinkAboutBuilding Permit Application (Renovation)All APPLICABLE INFO
MppU��ST BE CGr:,r:.ETED FOR APPLICATION TO BE ACCEPTw
Date: �� ,\-\ Permit Number:
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RECEIVED
- Building Permit Applicatio
Planning and Development Services
DEC 2 6 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
�' Lucle C , Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 1-1I O 8 % s
3`{q H9
Property Tax ID#: c'00`5-000-0
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION I INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
J/'Window's/Doors
ylectric _ Plumbing _ Sprinklers —Generator,'
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2— Utilities: —Sewer Septic
Building Height:
i
OWNER/LE-SSEE: CONTRACTOR:
Name Jahe, er-S+eie^.j Name:
Address: 6107 �'vl(evt %ewe, LaAe, =Company: _
J
City: State: `mot ; ` Address:
Zip Code: 1 Go Fax: City '
State:_
'2J
Phone No.Il(0L— ����q3 Zip Code:
Fax:
E-Mail: I P� S I a oa Gv Phone No'.*��
Fill in fee simple Title Holde 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.
DESIGNER/ENGINEER:
Name:
467
_ 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 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
POSTED ON THE JOB SITE BEFORE THE FIRST, INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITy,YOUR LENDER'OR AN ATTORNEY. BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
Signatur o Old_ ne / Lessee/Contractor as Agent for-Owndr...
Signature of ContractoULicense Holder,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY C C�
COUNTY OF
The for oing ins en was acknowledgg efore me
201 qby
The forgoing instrument was acknowledged before me
day 20_ by
of
this _ of . -
St\hii t�f;.,,lddaay
p
yans
a'mlJ— a of perF'' s making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Idle ion
Type of Identification '
Produced
Produced
(Signature of Notary Public -State of Flo 'd
Signature of -Notary Public-.State_of Florida) i.
KAREN S. NIELSEN
Commission No. �`��'"bBZ�; staoride-Notary Publi
ommission No.
=•I� commission N GG 207484
,(Seal)
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pires
:? My commission Exra
nm�
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