HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CONirec-TED FOR APPLICAT,(ON TO BE ACCEPTED
Date: 1-d v� �r r �' r i3''�`a Permit. Number:
RECEIVED.
_ Building Permit Application -
Planning and Development Services
0 C T 2 5 2019
Building and. Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
ST. Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772)'462-1578 Commercial Residentia
PERMIT TYPE:
Address:
Property Tax ID #: >� 329 M 0 (2 P j 0 I '° 0 u' � �
Lot No.
Site Plan Name:
Block No.
Project Name:
/"ALA n""
Additional work to be performed under this permit.— check all that apply:
Mechanical — Gas Tank - _ Gas Piping —Shutters
_zwindows/Doors
Electric d /Plumbing= _Spri 'klers Generator
, —
(r.Rdof:% . ;.: PitcVh'',
'
Total Sq. Ft of Construction: e, Sq. Ft. of First Floor:
Cost of Construction:$ _ 5$ �p�, '�Y Utilities: 2Sewer ! Septic
Building
.Height:,
SAS •
Name ►�_' Name: -
Address: �.� 'i�Q�x., - Company:
City:.,✓? , State. Address:6';
Zip Code: :.`', Fax: : ; City:
Phone No. F. Zip Codes'',
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
el � .e%I r�►►
from the Owner listed above) State or County License�`q
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.
M
PDESIGNER/IENGINEER:' .
Name:
_Not Applicable
MORTGAGE COMPANY:
Name.
Not Applicable
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 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 0WNER: 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 Ow r/ Lessee/Contractor aAkHt for Owner
Signature of tractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OF • LSJC;1L
COUNTY OF
The for ing instr ent as acknowledge before me
this�day of 2014 by
efore me
The or ing instru n w s acknowledgVby
thi day of 20
Nam of person making statement.
Name o person making statement.
/
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
f
Type of Identifn
(�
Type of Identif'io`-'- ''- -
Produced r L
i
Produced
-
(Signature of
(Signature
Wei
;; YP/1 KAREN S. NIELS N
KAREN S. NIELSEN
Commission
.a° �sState of Florida- yy�� Public
•=
Commissio
State of Florida-Notar Pu JJic
._ 'on # GG kA
Sion #�1�7ggq
�y Commission Expires
_
�9 o°�� My Commission Expires
o; oF,
June 12 2022
June 12, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19