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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEu II 2 2 Date: '1.19 • I 1 Permit Number: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: SCANNED BY RECEIVED St. Lucie County MAR 1 9 Building Permit-Applicatio�019 ST• Lucie county, Pefm Commercial Residential T Address: \ \�--? 8 Sl: ��C-Q S�.nx c-��k-, �--L-i\(S(j Property Tax lD #: q 4 ' 70�- ' b003 - D00 Lot No. Site Plan Name: Project Name: Additional work to be performed under this permit - check all that apply: Block No. _Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: %East of Construction: $ Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name �r� �1c> CC_�r n Name: Address: \C�� �� M�,�,� NL\v Company: City: Stater Zip Code: �i`lC� �-. Fax: Phone No. -2 7 3 L ( -5'D 6 ( Address: City: State:_ Zip Code: Fax: Phone No E-Mail: 0�1-;c� . _' G & \�G. r� Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State 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. SUPPHEMENTALC©NSM m LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: 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 thepermitholder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT" ignaturaof=Q ner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUN. COUNTY OF OFF I CIE The forgoing instrument was acknowledged before me The fo oing instrument wa acknowledge before me tI',hiis`day of 20_M by this _ day of 20_ by KWi =. I N N N I W�Fi K� Name of person making statement. Name of person making statement. i Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identific do Produced 1, (Signature of Notary Public- State of Florida ) (Signature of Notary Public- REN S. NIELSE State of Florida -Notary Pu Commission No. _ •- (Sael}ission # GG 2074 my commission Expir June 12, 2022 C mission No. (Seal) lic 4 s REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2/7/19