HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPfis�D FOR APPLICATION TO BE ACCEPTED
Date: 2T �i Permit Num
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FEB 12 2019
-- Building Permit Appli ation
Planning and Development Services Permitting Department
Building and Code Regulation DivisionSt. LUCIe County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 -- — -- - - _ - - - - -
—Phone: (772) 462-1553Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: t3GANNED
BY
ROPOSED IMPROVEME T LOCATION:
Address: 5H 14 Qa l rne-�o L`OC-1r e -1�k il'2rGC -f—G
Property Tax ID#: ;,Aria - wi - 023LA - 000 - 5 Lot No. 1-1fl
Site Plan Name: nmzr- re.�ati. `� %o a. Block No.
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Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORM TIONs
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: q 0 rr Sq. Ft. of First Floor:
Cost of Construction: $ 2 000 � 00 Utilities: Sewer —Septic Building Height:
OWNERf LESSEE.
CONT C�TOR:
Name
Name:
Address: SN14 &y-ve 17r:df;
Company:
City: Yoc•r Pzerc-,e, State: 'F
Address:
City: State:_
Zip Code: Fax: -77Z- 3N0— 226o
Phone No. '561- (oKK - 3085,
Zip Code: Fax:
E-Mail: �: owrv�i. ® k I em
Phone No
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Fill in fee simple Title Holder on next page (if different
..
E-Mail
from the Owner listed above)
Stat 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.
FORUM I ENTML GONSTRUC-TION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: 0. � \
MORTGAGE COMPANY: _ Not Applicable
Name:
Address..l ,Iv1
Address:
City:.e?o r4 S* . J ,%, = " State:
Zip: a�41� Li P onh a dA�2— ?85 —5eB8
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 thatno 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,our Home Owners Association and review your deed for any restrictions which may apply.
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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 BEF DING YOUR NOTICE OF COMMENCEMENT."
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Sign ❑re f •, ner/ Le ee/C as Agent for ger..
Signature of Contractor/License Holder
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STATE OF FLORID - I
STATE OF FLORIDA
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COUNTY OF z ms9
COUNTY OF
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The fo oing instru t was acknowledged before m > s=
he forgoing instrument was acknowledged before me
this day of 20by N; 9
his day of 20_ by
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Name of person making.statement.
ame of person making statement.
Personal n OR Produced Identification
Personally Known OR Produced Identification
Type of Identific '
Type of Identification
Produced
Produced
(Signature of P#tary 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
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