HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLI BL INFO MUST BE .(
Date:
FOR APPLICATION TO BE ACCEPTED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: Q C , �
Address
Permit Number: \C\03
RECEIVED
MAR 0 7 2019
Building.Permit APpli �MQM�oni , Pnrrni6.n
Commercial Residential
Property Tax ID #:.0 3C)� - �J t --[_,C>bj
Site Plan Name: LL n Naantsrs
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 _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: «�
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
FEW NE8""MIRS SEE:
CONTRP►C`tOR:
Name
Name: (I 0_
Address: apy
Company: v U -
City: �F�Qice- State: mil_
Zip Code: 3q0tt4S' Fax:
Address: �2bl �,AtMA3>✓ W- �l .O
City: 1 -t•State: 7--
Phone No. y 6(®-2�t23b
Zip Code: SgONS- Fax: 772-y &-226Y
Phone No '1 .L1 -22i (_�,
E-Mail a e L( °C
,,-27:L.-
E-Mail: P� _ cic 2,61N .aw"Z , C.,ow-.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License ( L (2S 7 71-7
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.
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DESIGNER/ENGINEER:
_Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
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 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) 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
wrlirwmUNTIENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." '
Signa ure of C?pV`actc;_r/Lice_nsrH,6Ider
Si ure Owner Lessee/C ntractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORA
COUNTY OF 5�. �- ��
COUNTY OF .
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1 day ofa 20� by
this 1 day of Md t 20 by
CV, tA3 --V\ -iA4�k
C1\t-\S�r` s.\V\ �A\�
Name of person making statement.
Name of person.Making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced'.
Produced
Pir S EN
(Signature of Notary Pu ic- State of Florida)
(Signature of lic- . �W1@tffitl p22o2s
���MpR1EGNENS023
Commission No.6av (diSSION#��0n
EXPIR December 18,a 0201ter
MCommission N „�,yPubl'
.`�r:»:a�¢,••, MX r,pM mbet 16,26 r�►ere
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FRONT "°
SUPERVISOR
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MANGROVE
COUNTE .,
EVIEW
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DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19