HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL'err O FOR APPLICATION TO BE ACCEPTED
Date: Permit -Number: e? O J Q o2 4q
_R==- RECEIVE®
Building Permit Applica ion JAN 1 5 2019
Planning and Development Services
Building and Code Regulation Division Permitting � partmerlt
2300 Virginia.Avenue, Fort Pierce FL 34982 St . U e OU rlty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Re
PERMITTYPE: IF 0;?e tVA ✓ 7f-I
PROPOSED INPROVE- ENT LOCATION:
OL,ED
Address: ' �i�� S d eirrw �d2i/�i %/t9% f %
PropertyTaxlD#: AgY11-'k1P,%i1)W,--o 4 7i Sr �U $0t
Site Plan Name: Block No.
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Project Name: w1 1111p l /G 10�, 4N/;hn fir
DETAILED DESCRIPTION • F WORK:
CONSTRUCflO NFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers —Generator _ Roof Pitch
Total Sq. Ft of Construction:®� Sq. Ft. of First Floor:
� Cost of Construction:$ 7Z_'f Utilities: _Sewer _Septic Building Height:
0 NER/LESSEE:
CONTRAC .M
Name
Name: —
Address:
' G V!�- 10TO
Company:
n_S_j
City: ,-h? /�L k+a6 1 State: _
Address:
City: State:_
Zip Code: s aE7 Fax:
Phone No. SI'
Zip Code: Fax:
E-Mail: SI d �`I3Yl2GVL�rr>Pi�
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
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.
SUPPL M , TAL GO ST 'UCMON LIE LAW IN
-O M71TION:
DESIGNER/ENGINEER: ,
Name: r /0 W 61
_ Not Applicable
teeltl6 .
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:-� f.✓L - ' d-`
Zip: �_ Phone
1
State
-
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: r, _
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
Cify:
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 bf 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 tfie 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
PTO O ER: Your failure to Record a Notice of Commencement may result in your paying twice for
✓ements to y ur property. A Notice of Commencement must be recorded and posted on the jobsite
the first ins ection. If you intend to obtain financing, consult with lender or an attorney before
encin or or recording our Notice of Commencement. s
gnaw f Owrier essee/Contrac or as Ag
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Signature of Contractor/License Holder
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STATE OF FLORID
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STATE OF FLORIDA
COUNTY(
o-
COUNTY OF
The fo,,r�oing mstru nt was acknowledged be
�Nw
¢ �
The forgoing instrument was acknowledged before me
this day 20 b
a -,w a
this day 20_ by
� of
m
_ of
b�0 e ✓a n
Name of person making statement.
g,.
Name of person making statement.
Personally Known OR Produced Identi
Personally Known Olj Prodiced Identification
Type of Iden 'ca
�i
Type of Identification
Produced a • C
Produced
(Signature of Aitary 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
I
DATE
ffig
COMPLETED
Rev. 9/2b/18