HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BA COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit f'um
KtCEIV'D
a
�. AUG N '2019
Building Permit Appli ation
Planning and Development Services Permitting Departme')fi'
Building and Code Regulation Division St. Lucie County,w
2300 Virginia Avenue, Fort Pierce FL 34982 - -'
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
4
PERMITTYPE: 6 V
P +'+S-
Address: �`
o 07
17
Property Tax ID #: / �� �lo �2 Od Dk5e _ 7 Lot No.
Site Plan Name: Block No.
Project Name:
D All. � DE5C +IP ICl OF OFtK:
—peg r
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters ' // Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _L-1 Roof ' Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
/J G
Cost of Construction: $ t l '� Utilities: _ Sewer _ Septic Building Height:
EV, N R/LLSSE
Name: V�
Name -pig �.
Address: 7-5' L
City: '2 r4' State: _
Zip Code: �% �% `Fax: '
Phone No. ' �� . ��' ® 7 lLIf •
1
Company: 9 Co
Address: r aid 2
City: State:
Zip Code: �2 ��� Fax
Phone No 777—— y-13 2��
E-Mail
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_
State or County Licensee'
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.
DESIGN ER/ENGIN/E,ER: _Not Applicable
Name: c,.tk
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: Oct 'i i 2
Address:
City: State: ,
Zip: Ph6ne772-,(33-/ 0 ,22
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 FIR T INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND IZ ORtAN ATPIDRNEY BEFO E RECORDING YOUR NOTICJhOF COMMEN EMENT."
Signature - Owner/ Lessee/Contractor as Agent for 0 ' ner
Sign atu of H Contractor/License older
STATE OF FLORID
STATE OF FLORI
COUNTY OF
COUNTY OF
efore me
The forgoing instrurymnt was acknowledgWby
this day of Z 20
The for ing instru ent was acknowledg before me
this % day of 20 �� by
Name of person making staters .
Na Vperson making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N t ry Public- State of Florida)
(Signature of Nota ublic- State"of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.