HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONd APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. 0 Permit Number: I / v
--------�---ter
0
FEB 2 S 2019
Building Permit Applica ion
Planning and Development Services _�- Permitting Department
Building andCo�ulotionDivision St. Lucie unt _2300-Virginia Avenue, Fort Pierce FL 34982 v, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: K1 •e,>a �? i �� ��,Y, Y1 l �l PZ2S i d e h C oe, SCANNED V
Address:1 :1
Property Tax ID #:
Site Plan Name:
Project Name: _
Mr&JQ=40.�IiYM al �J
y
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
lechanical ✓ GGasTank ✓Gas Piping _Shutters _Windows/Doors
_L-flectric " Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: �3 5 s S Sq. Ft. of First Floor: 53 5-5-
Cost of Construction: $ at Lt Ly6j 6iG Utilities: e5e_wer- �ic Building Height: /0
OVINERjLESSEE p
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QITR4CTOR.
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Nam A laflir4 9 i
Name:
1 er—
Address: 1 i
Company:
City: State:
Zip Code: 34 4q_!S Fax:
Phone No. 7,2- 3-7- 36 e/?
F%
Address:
City:
Zip Code: Fax:
Phone No
State:_
E-Mail:
Cm_� S qG @) yjgx ,cA. Cow
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
-State roeCounty License
If valueonstructro-d-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 CONSTRUCTIONsLIEN tAW INFORMATION
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DESIGNER ENGINEER:
NotA Applicable
Applicable
Name: b! PP MORTGAGE COMPANY: Not Applicable
e c n dine:
Address: Address:
City: � State 1 City: State:
Zip: Phone 7 321—f1Sc5o Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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.
which is In conflict with any applicable )Home Owners Association) rules authorize
structure. Please ylaws or an Scovenantermit s that may restrict prohibit such
or
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 the Florida
plans, 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 insp ction. If you intend to obtain financing, consult with lender or an attorney before
commencin wor or rec din our Notice of Commencement.
Signatu of wner Lessee/Contractor as Age
t fgpA '
r
Signature of Contractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA
COUNTY OF
" e.
COUNTY OF
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ofi w� a
N u
The forgoing instru nt was acknowled d be
g
thi day of
The forgoing instrument was acknowledged before me
J 20f�j' b
¢ gx
this _ day Of 20 b Y
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Name of person making state en[.
Name of person making statement.
"soe4
Personally Known OR Produced Identi a
Personally Known OR Produced Identification
Type of ation
Type of Identification
Produced
Produced
(Signature of NcMry Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
IEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIO
_SEATURTL�-MANGROVE
COUNTER
REVIEW
RE IEW--REVIEW—
EVIEW
REVIEW
REVIEW
J
IVEDE
PLETE