HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �j h
Date: � �% • 1 . l 9 Permit Number:
Building Permit Applicatio DEC 0 3 2019
Planning and Development Services ST, LUale Coun , Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROP05ED IMPROVEMENT LOCATION:
�PriipertyT Ixa Ixa o 3 yd9-703-Ooy8-nv0-O
Site Plan Name:
Project Name:
Additional work to be performed under this permit- check all that apply:
Lot No.
Block No.
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing '`_Sprinklers
Total Sq. Ft -of Construction 3/,;t �C9a2 ' 5/>hcQ
Generator - - Roof Pitch
Sq. Ft. of First Floor:
Cost of Gonstcuction:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namf' inroh
Name:
Address: 6377 G:1gfk.I iT
_Company_:
City: Fmx7r .n��Q�g State: /=Lq.lAdd?ess
J"
Zip Code: 3Ni sra Fax:
Phone No. 06=6%ZS9 ;Zip
1Vi C 614H r
.." 'n w i'U. +. 'A.Qf -
I City.• nc '. 5 + ,. i:' ': State:_
Code:, - /,Faz,
EIMail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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.
PLEMENTAL GONSTRUCTIO IEN LAW I
ORMATIONI
DESIGNER/ENGINEER:. _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not 'Applicable
Name:
Address:-,
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER; _ Not Applicable
Name:
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 covehants'that may restrictor prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions whicKmay 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."
Signature"of Owner/ Lessee/Contractor as Agent for Owner
Y:_ —I—,-
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF I JOA F .
COUNTY OF
The f going ins ument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20j% by
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification "
Personally Known OR Produced Identification
Type of Identif tion
Type of Identification
Produced
Produced
(Signature of Nota Public-
State of Florida
(Signature of Notary Public- State of Florida)
cY "�a, KAgqENN, S. NIELSEN
,State bigq ride -Notary Public
Commission No.
Commission No. (Seal) '
`-_ •= Commission # GG 207484.
My Commission Ex fires
•"nin
Jun
12, 2022
REVIEWS
FRO
PLANS
VEGETATION-
SEATURTLE
.MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
'DATE
RECEIVED
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DATE
COMPLETED
Rev. Z///1!J