HomeMy WebLinkAboutappAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nu
f7 7
RECEIVED
Building Permit Appl cation JUL 1 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: I r-f ce zkn'A-S
Property Tax ID 8: Lot No.
Site Plan Name: Block No.
Project Name:
1
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator ')ORoof 4//� 7'Pitch
Total Sq. Ft of Construction: Jid i Sq. Ft. of First Floor: ^T-`
G 31
Cost of Construction: $ v LA, Ei Utilities: _Sewer _Septic Building Height:
Name Name:OA'r TIF"
Address: ¢ Company:
City: StatesW Address:
Zip Code:.3*%V S Fax: City: State:_
Phone No.� n--sO1l7 Zip Code: Fax:
E-Mail: `fuk6--N as e 0,0 coywN Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
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.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
6N 4 W &rK&CV'-
Signalof Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL OR
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing ins' u rtfwas acknowledgef�before me
The forgoing instrument was acknowledged before me
vl this J— day of 20 • by
this _ day of 20_ by
C,u ,rl C r --,,T
Name f person making statement.
Name of person making statement.
/
Persoaapy Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id ifi ation
Type of Identification
Produce
Produced
(Signature of Notary blic- State of Florid
(Signature of Notary Public- State of Florida)
.."••. AUDREYB.%�U�M,��HREY
Commission No ='�' �'` MMISSIONS�l3G 300817
Commission No. (Seal)
EXPIRES: March 6, 2023
REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
FRONT
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z17119