HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE NFO MUST BE COMPTTED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nui
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Buildin%EATE9 Ap
BY
St. Lucie County
Commercial
PERMIT TYPE. 0 CJ-iv-pbaz.:
Address: 4W �5 3/6C O&A,
Property Tax ID #:
Site Plan Name:
Project Name: OAZ.4ayQ
,A
APR 2 2019
cation
Permitting Department
St. Lucie County, FL
Residential
N t7y• - �
Additional work to be performed under this permit— check all that app
�l
_Mechanical _ Gas Tank _ Gas Piping s„ .; •? ';
Electric _ Plumbing _ Sprinklers
Lot No.
Block No.
Windows/Doors
_:Roof Pitch
Total Sq. Ft of Construction: IV Sq. Ft. of Firsf Floor:
Cost of Construction: $ 41.S00. Ov Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C>
ame:
Address: a
Company:
City:State: —
Zip Code: % Fax:
Phone No. — O 0
-Address:
City: State:_
Zip Code: Fax:
Phone No
E-MaiIII : / G
Fill in fee simple Title H Ider 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.
DESIGN R/ENGINEER: Not Applicably
1 i+
NaIC f17`
City:tyUc1;,,, _ State;
zip 7A Phoneme ^_
MORTGAGE COMPANY: 'Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone
_Not Applicable
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
POSTXP ON TH OB SITE BEFORE THE SPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT OUR LEAPER OR AN ATTORNEY Ll CORDING YOUR NOTICE OF COMMENCEMENT:'
_ r�e of r/ essee
or as gen
rj
Signature of Contractor/License Holder
Wig
T TE OFF O ID
m
STATE OF FLORIDA
UN
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COUNTY OF
OF
The forgoing instrument was ack wledged before me
The forgoing instrurr&nt was ack owledg befo
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this _ day of 20_ by
this day of20
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bif
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C G I
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Name of person ma 0g statement.
Name of pe son making statement. '" •r•• "
/
Personally Kno4k OR Produced Identification
Personally Known OR Produced Identification
Type of Ide ification Produced
Type of Identitrat n
Produced
S ignature of Notary Public- State of Florida) =
Commission No. (Seal)
(Signature
(Signature of o ary Public- ate of Florida
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
)
DATE
COMPLETED
Rev 2/7/19