HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f ' 11 rI
Date: �• Ill. `9 P2rmit Number: `-t 4(o
,
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
Building Permit Applicaikion APR 17 Z019
ST. Lucie County, Permitting
Commercial Residential
rpeo'p rty_T;axxlD`# % 0,3 �6a p /!�6 DG U/ Lot No..7
Site Plan Name:
Project Name:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing
c _Sprinklers
TQtalrSq*,Ft.of Constructions 4 4 Sq
G o, c
CcslljofaCogstruct'ron: 4 ,$66 _' ,?,00 Utilities:
Generator
Ft. of First Floor:
Block No. 9
Windows/Doors
Roof Pitch
_Sewer _Septic Building Height:
OWNER ,LESSEE:
CONTRACTiOR:
111,,,rrrr��x....
%v me 3- e s i
Name:
A, dress: 33S 1-10A; ,..,,,
Company:
Ci y: L,,, P ere. rare. State: r/.
tZi Code: �3 Y 9 S%2 Fax: �/dhe
h ne No. %%1' Z 65 01— J.2 F -6
Address: r
City: State:_
Zip Code: Fax:
Phone No
E - ail: 1Yo r,
3I'llri
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.
SUPPLEME-NTAL CONSTRUCT LIEN LAW INFCIRMATION:
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 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
P DON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
ITH YOUR/LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signs ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLL_�RID1A
STATE OF FLORIDA
OFUN� It,
COUNTY OF
The f r ing instru a as cknowledg before me
this day of ( 20 by
The forgoing instrument was acknowledged before me
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification Produced
Produced
)
(Signature of Notary Public- State of FloridaILL
Ito mission No. (Seal)
ublic
es
s
(Signature of Notary Public 11 ,,,on AREN S. NIELS
P`" State of Florida -Notary
Commission No. - o. ("mission H GG 207
My commissio2n022pi
June 12,
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
I
RECEIVED
I
DATE
COMPLETED
Rev 2/7/19