HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED APPLICATION TO BE ACCEPTED 1 (� (�
_Date: _ d2 - �i 'l % - --- - Permit -Number: L q
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
RON, /
Building Permit Application p9r FFs o� F°
Sr/hi�y ?�I9
Commercial Residential
PROPOSED INPROVEMENT, LOCATION.
Address: ;�4qI? / fkOG
PropertyTax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION
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WORK:'
Lot No.
Block No.
/ 1-1XU 060h ��� .5 �2s - ire a ' V00 (-UVnb!D
CONSTRUCTION INFORMATION
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction: $_396 Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
;OWNER%LESSEE:"
-CONTRACTOR:
Name 0-
Name: n r
�i
Address: 7/ L%,PS D
company: D3-p 6ewa l
1 r �yc 37,C
City: T l72-t�LL� State:,EjL
Zip Code: 3�y�'/ Fax:
Phone No.
Address: 33/ ono/� s4✓
City: Fr pltxzE State: Y (-
Zip Code: 3' q1 Fax:
Phone No - q-779'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail he; 6F-
/, C
State or County Licens C
5-/ 41
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work orr-ecmding vour Notice of Commencement.
as Agent for Owner
STATE OF FLORIDASTATE OF FLORID
COUNTY OF_ �_ �,l Ct AJU COUNTY OF � . U_X_�
The for ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of "YL20AOA by pwra�n2 this �cda of17 � 20 by
1
Name rson maki g tatement. Name of p rson makin tement.
nally PersoKnown OR Produced Identification Personally Known�sOR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No.
REVIEWS
RECEIVED
AM". BOYD
Notli ,190*lic, State of Florida
Commission No. FF 205666
ee., r.nmm- Em. April 1, 2019
FRONT ZONING
COUNTER REVIEW
(Signature of Notary
Commission No.
State of
SUPERVISOR I PLANS I VEGETATION I SEATURTLE
REVIEW REVIEW REVIEW REVIEW
BOYD
blic, State of Flulio
ion No. FF 20566
MANGROVE
REVIEW