HomeMy WebLinkAboutBuilding Permit Application►il APPLICABLE INFO MUST BE COMPL'reJ FOR APPLICATION TO BE ACCEPTED J %
Date: 1 ' ,2L.e') Permit Number:—) "1
R Ec-= C E I Yo
Building Permit Application NOV 2 6 2019
Planning and Development Services Permitting Dep ent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 . • St. Lucie nty, FL
Phone: (772) 462-1553 'Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: -:!r 'A-,D
Property Tax ID #:
Site Plan Name:
Project Name: `
Additional work to be performed under this permit- check all that apply:
1,,, e�cha�nical _ Gas Tank _ Gas Piping _ Shutters
_ EL/ lectric &�-rrumbing,/ _ Sprinklers _ Generator
Total Sq. Ft of Construction: 'p� T Sq. Ft. of First Floor:_
Cost of Construction: $ �` �® Utilities: —Sewer _Septic
® `(
Lot No.
Block No.
_ Windows/Doors
Roof Pitch.
Building Height:
Name X W a vl6 SOh Alibi 14 1, t ) l�5 P
Name: /
Company:
.e `+�
2--'Z-.,f4fiV4
Address: '`a2490 �'7®.
City: 1 "A- P,e red' F State: _
Zip Code: --,S`/ Ql2- - Fax:
Phone No. -1"72 '/n9 432-3
Address:
/S //
City: I/��
Zip Code:
Phone No
Z i! C State:, 'e.
3� �f�7_ Fax:
-i2-4A -14e
E-Mail: 71::�) SASIA'pr IS-10 (T) GW4Ckd-r0'v"
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail p eeez4y�a-7—
State or County License. / xl
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.
II 7
NEER: • _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Citv:
Zip: Phone:_
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 subjectstructure
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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
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
(Signature of Notary'Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name"..", �� cue, 2410=701 _ Name:
Address: _c?,d Su1 Address:
'City:. .S- Z.; ,e' State: ;mil City: State:
Zip: y.3 48 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
PATH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
' nat e o or/License Holder
e ne essee/Contract as Agent for Owner
STATE OF FLORI
STATE OF FLORID
COUNTY OF
COUNTY OF `
The fg�goIng instrument as acknowledged before me
The f ,o0. g instrum nit was acknowledged efore me
i%1/ 20�by
this.�C.rS day of �% 201Q by
this a:C�1 day of
f
Wd
P✓ :c Iko,6 ev mek
Name of person rnak4 std a ent.
Name of person makin st tement.
Personally Known . OR Produced Identification
Personally Known OR Produced Identification
Type of Identif tion
Produced jJ'f'
Type of Iden '. tcation
Produced a� 1/�(� ?t l� �/�,����--
l/
(Signature of No -
AUDREY B. HUMPHREY
(Signature of to Public- State of F16rida)
�PP;r,?ia •
�o ' ''; GG 300817
Commission No. MYCOMMI�$I
4�PYPU
Commission N 0.- eL =, AUDREY$. HU 11'�dS Y
'l CCI6AMISSION # GG 300817
EXPIRES: March 6, 2023
. *:
ded Thru Notary Public Underwriters
%;; G% �`.•` EXPIRES: March 6 20
9 ^
_ -.,^ ,• _�O_nc
ed Thru Notary Public Un
erwiters
ROVE
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
'REVIEW
PLANS
REVIEW
VEGETATI�~
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19