HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date Permit Number: ]9r.-)W-N I � O
RECEIVED
Building Permit Applicftio:nPlanning and Development Services AR 18 2019
Building and Code Regulation Division2300 Virginia Avenue, Fort Pierce FL 34982 ie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
PERMIT TYPE: �NNLU
� �� S Y
PROPOSED IMPROVEMENT LOCATION: St Lucie County
Address: �$ S _ Us:
Property Tax ID #: Z2 - L `�4��� -3J �6 Lot No.
Site Plan Name: _ Block No.
Project Name: s us -
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
✓Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
,-'Electric -"Plumbing Sprinklers
��> % Total Sq.' Ft of Construction:
Cost of Construction: $
— Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i.(- C,
Name:
Address: •5 C
Company: v.
City: State:
Addres : `ASS 3 V) i
_
Zip Code: l ky'U?� ax:
City: k State:_L
Phone No. Q 5l,- 5 K 4 L_00
Zip Code: Fax:
E-Mail:
`Phone No 9 S4, - 5 9 W —
Fill in fete simple Title Holder on next page (if different
E-Mail S @cyz
from the Owner listed above)
State or Count License L' 0
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State'
City: State:
Zip: Phone
I •
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: I
City:
Zip: Phone:
Zip: 1 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 FA TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR 1 M TO Y UR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
WITH Y R LE E J SITE OR AN ATTOR THE FIRST INSPECTION. IF EY BEFORE RECORDING YO Y NOTICE D TO OBTAIN COMMENCEMENTNCING, CONSULT
I
I
4gnatuof
Signature of Owner/ Lessee/Contractor as Agent for Owner
on ractor/License Holder
I
STATE OF FLOIIM�D
`1�od��< to
STATE OF FL941DA
COUNTY OF C.t, �
COUNTY OF -61=0A
The f rl ing instru t wa acknowledged before me
The fo ing instrum t was cknowledged before me
May
this ay of 20� by
this of 20Iq by
LUio, % (;'-n L�sr e a
Name of person makin statement.
Name of person mak=OR
PersonaIlly Known OR Produced Identification
i
Personally Knownuced Identification
Type of Identific tion
� VL
Type of Identification
Produced
Produced •
I
�ISSXTAI_p
(Signature of Notary ublic- ,Flor"P N # GG 20
,O�MtgS10 15
(Signat re of Notary Pub'e
S
;`i►iY! ILIRABf=_ H@RNI€6f.E3ATAWA
Commission No.
SSION9GG03676
/_ ' `= M� �ESOctobes
Commission No. V
'•',? ,. dXPIRES October 45, 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19