HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE&','OR APPLICATION TO BE ACCEPTED \-q
Date: 1 Permit Number:
SCANNED KtcEIVED
&X-411 no BY
s St. Lucie County PR 1 1 2019
Building Permit ApplicatiLA
cie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: ��N \Lac Aar'3-
Address:
Property Tax ID #: �.y�^�Gd� O�� (77 Lot No.
Site Plan Name: Block No..3 („
Project Name:
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank _ Gas Piping —Shutters
Electric — Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer Septic
Windows/Doors
Roof Pitch.
Building Height:
OWNER/LESSE
CONTRACTOR:
Name lYIec)
Name:
Address:
Company:
City: State: O-L
Zip Code: 6-"/95 —/n/1C -Fax:
Phone No. o - ctQJ %�
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 'gzo.�-Y ��(F.Q/tnr
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.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Zip
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable .
Address:
City:_
Zip:
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:' `
�Owner/
Signature of ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY L Zatl'�
COUNTY OF
TT
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this %\ day of -S � . 20� by
_
C x ^ [1 A
� � C , G c7
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced l (� i� li
(Signature of Notary Public -State of Florida I
Commission No. (Seal)
(Signature of Notary P
E�ANQNA GIVEW
@
Commission No.
SMARI
MY 19,"GG D22023
' Q��' ' - IXP1fi Ddember W. 2020
Bonded Thrµ•Notaq Public Undenxriters
REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19