HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
��77
Date: )� J�'' / Permit NuTbe ICEBuilding
Permit Appion DEC 10 2019
Planning and Development Services Permitting Department
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie nty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ReSI entla
PERMITTYPE: kn n
✓� '
PROPOSE�DIMPR01/EMENT l? � CA ION:
Address: �y
t'!D f+Pi/]2(�
�7 I �/
Property Tax ID #: g - mac I - Q I PO - oI a - "1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION 10F WORK:
C e, r7
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas k _ Gas Piping _ Shutters _ Windows/Doors
�l�tric Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ��� Sq. Ft. of First Floor:
Cost of Construction:$ C)f000 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: o
Company:
City. ire:-492 Stat Vf,--
Address:
City: State: —
Zip Code-V Fau�x�.r
Phone Nd. 4 a- ag �Y'17�
Zip Code: Fax:
E-Mail:fV' GU II�Q(O!SOaQ(,ODV1�
Phone No
Fill in fee simple Title Hol er on next page (if different
E-Mail
State or County License
from the Owner listed above)
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.
SUPPLEMENTA CO--SfRUC 101 LIEN I
FOR T 0.
MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGN ��EIIR/ENGINEER: Not Applicable
Name:
AddrUs:[i2C I S L f; 0 a,-
a t..9
Address:
City:f l 4 b
Zip: ��y l� Phone (01.
State:
y71 C) �
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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, 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."'
3Ay'Afi , L.lrvt tj\
c4ignatureofr0�4tieP/YLessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF VLF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _0day of 7rIC , 20]K by
this _ day of 20_ by
TRry)e•( 4,0r p l
Name of person making statem6nt.
Name of person making statement.
Personally own OR Produced Identifications
Personally Known OR Produced Identification
Type of Iden i i tin
Produced alyC
Type of Identification
Produced
lic-
(Signature of Notary State of Florida j
of Notary Public- State of Florida )
Commission No. ALDREyB.HU
'g� AIY COMMISSION
PHREY '
jpp Isi No. (Seal)
EXPIRES: Marc
6. 2023
_1' _
:�.
"�FOFf ��te
B0�
REVIEWS
FRONT
ZO
ISOR
PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/1/19