HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
Date: �°..�-�/ ��. Permit Number
FR.
RECE&I
..
Building Permit Applic tion
DEC - 9 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. LUCie Count
2300 Virginia Avenue, Fort Pierce FL 34982 y, L
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: ate) C_
PROPOSED IMPROVEMENT LOCATION:
Address: 212 14e,--} (ems` _231YJ 3y951
Property Tax ID #: L4 5D 2. - 50 — 04 52)— C)ollo
Site Plan Name:
Project Name: LO+-
DETAILED DESCRIPTION OF WORK
i��s � d 1 na us i no► h o�.r� � �
CONSTRUCTION INFORMATION:
0
Lot No. Z-7
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: 5 Lj Sq. Ft. of First Floor:
Cost of Construction: $� 00 Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE; . o
CONTRACTOR:
Name G&t�1 fdVQ.n
Name: Go_ OVe,
Address: 2.1 2 N&A [P-S -13 1 vd
Company: Zl Z KE ILLS 1 V cj
City:State: 1
Address.
Zip Code: 75149 5-1 Fax:
City: ext e.rZ State: F I
Phone No. (cl to Zq 5 3i,q
Zip Code: ':�H9 Fax:
E-Mail: gSJ!g7 js 33od +e.,1 CO . ne,+
Phone No l0 2q 3 31-'1
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
it value or consrruction is >&Suu or more, a KECUKDED Notice of commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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
W11TH, YOUR LEND AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ignature Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this I?day of 6— 20_M by this day of , 20_ by
Name of p rson making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific Type of Identification
Produced 1 A Y-)) j Produced
ad Z-C� 4r'\.Jwyn4:��
(Signature of No bly
Public- State of Flori a) U (Signature of Notary Public- State of Florida )
Commission No. y� AU Ey d.UAOHREY Commission No. (Seal)
COMMISSION # GG 300817
"9'FaF V':, 0 Boi ided Thru Notary Publi . Underwriters
REVIEWS _ OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19