HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,� Date: , O(J . 1 6) Permit Number: I -/ D3� 0 STa_� .
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: r j-Aj_ L
Building Permit Application MAR 2 6 2019
SCANNED
BY Permitting Department
Commercial St. Lucie Cop dgtil yci ?Obuntyr FL
Address: 0 !! T05 _f511td 1 I(Jee
PropertyTaxlD#: A _34D4 600S Oifqz::�/
Site Plan Name:
Project Name:
Additional work to be performed under this permit —check+all ffi'dt apply
_Mechanical _
Gas Tank
_ Gas Piping ;_; � 1 iShutters
Electric
Plumbing
Sprinklers)'r -j ;4 Kis Generator
_
_
Total Sq. Ft of Construction:$
(� Sq: F.t.,6f;First Floor:
Cost of Construction:$
UtilitieS:Si;_4v Seer
_Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
MON ER7Z 0 4 ' ICONTRACTOR:
Nam UP LA Qv
Name:
Address: lWr GL?
Company:
City: ��� State. a
Zip Code: [TJ Fax: ''//
Phone No. '� %P5 41 q& �
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: SIde5t!gfl OP0110144
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: f I Name:
Address:. Address:
City:r., Stater_ City: State: _
Zip: A Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
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 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."
SigiaTt "of Q rY2 Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA y,..,
TATE OF FLORIDA
COUNTY =s.
OUNTY OF
OF
he forgoing instrument was acknowledged before me
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The If ping instrument was acknowledged before
this Xday of t tAep.G#- 20)1. by
his _ day of 20_ by
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PME14 Al Ly ea u4+ t
!
ame of person making statement.
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Name of persorf making statement. _
✓
ersonally Known OR Produced Identification
Personally Known OR Produced Identificati"
ype of Identification Produced
Type of Identification`'
Produced
(Signature of Notary Public -State of Florida)
Commission No. (Seal) C:
)ollltaaryry"'Public-!S�tatt�e
(Signature cif cf� lorida ff
a
Commission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19