HomeMy WebLinkAboutBuilding Permit Application-A
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit ApplicatiodOV 2 5 2019
Planning and Development Services Perm{ttiitcJ Der M
Building and Code Regulation Division Sro '�k��rtill�]'g
2300 Virginia Avenue, Fort Pierce FL 34982 Lucie cC)L1 . , �L
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentla
PERMIT TYPE:
Address: 3 P- CD d s' `� ! v�� '"70--
Prope't } =Tax ID #: 2 r w 0- Lot No.
Site Plan Name: liL�c��'! S° m �a Block No.
Project Name: aA A w
eo P,a�r(�
Additional work to be performed' under this permit - check all that apply:
L-'Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_VElectric _ lumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: j!� -;7- Sq. Ft. of First Floor: Z
Cost of Construction: $ Utilities: Sewer _ Septic Building Height:
NA`e `FOU1' %'1C—\SO A 0 AN V ' °ol p Name: C----r 2-e
d'dress:S?-00 #i S� 7D Company: �' ����/ %�� l� L-,�' �^
Cit': "FO f Pl%eW � I r9 State: _ Address: , S/l /,:�
Z
NIC11ode: Q Fax: %'7Z `��R 2� city: �ifP State:
Phoi a No. �� ®� �32 g° Zip Code: 5V17,6 , Fax: -�
E I il: S�vi ���!" I ��� P Com&' I -e0W1 Phone No ?Z--- 62.2- ! ��
F� in fee simple Title Holder on next page ( if different E-Mail, YX9
from the Owner'listed above) 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.
- a
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name'?"S_ e cue, Zrloe.7ol
Name:
Address: "?,50 �l..n^
Address:
City:. ,1 e-11 State: ,0i
City: State:
Zip:,3 YS Phone _
y
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 concuerency 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."
nat e o or/License Holder
e nssee/Contract as Agent for Owner
e e
STATE OF FLORI
STATE OF FLORID
COUNTY OF-'
COUNTY OF `
The fg�,gooing instrument yeas. acknowledged before me
The f¢ offing instrumgniwas acknowledged efore me
this.<3 day of Tl/ 20" by
this day , 20by
O ne 1&
Name of person makin st tement.
Name of person rnak4 stitoeRit.
Personally Known OR Produced. Identification
Personally Known OR Produced Identification
Type of Identif tion,
Produced
Type of Iden ' ication
Produced
*FHda 4
(Signature of No -
(Signature of to Public- State 1
•.;�PpY PUP'•, AUDREY B. HUMPHREY
= o. `c''; GG 300817
Commission No. MYcoMMI$I`Ij
_ •gYPU ,,
_
Commission N os' :, AUDREY B. HU awa Y
EXPIRES: March 6, 2023
<=s:
t; MISSIOi�d # GG 300817
ded Thru Notary Public Underwriters
Ron_
' = ,Po,.' EXPIRES: March 6 20
on
ed Thru Notary Public Un
erwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATI
ROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19