HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONF'
All APPLICABLE INFO MUST BE CO
ivIvuETED FOR APPLICATION TO BE ACCEPT2u'
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: Pe-ROOC
P' (.POSED IM ROVEMENT LOCATIO
Permit Number: 1 f5 - 33 3
SCANNED `
BY RECEIVED
St. Lucie County
MAY 14 2019
Building Permit Applicati n
5T. Lucie County, Permitting
Commercial Residential _K
Address: 7�49 L 'n. 4d'der nr rorl p'�efce C-L1, ?1499r2
Property Tax ID #: 3 So �z -323 - Q00a - pop- J
Site Plan Name:
Project Name:
Lot No.
Block No.
:6pye55 Douce i ear oFl �. aa� SI�reS Lr S hall 3rJ117 tiv �ev lay uan✓� 0.rr�
ri J 6Y p n2'fEipi�
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: 7!5.01►' Sq. Ft. of First Floor:_
I�
Cost of Construction: $ 3*190.00 Utilities: _Sewer _Septic
Windows/Doors
Roof A Pitch
Building Height:
ONNEM/LESSEEt
CONTRACTOR:
Name DAy1'.eI U D "U0.r\
Name: Ar,o." KigS ,v a.y✓"L
Address: Fla 3 77nXy, Rwcr nr
Company: 5bwr 5e_ ' RooC="+r, LL C
City: F 0 fk g ier[e State:
Zip Code: 3L '?T9-- Fax:
Phone No.
Address: l t S C m.A I o1
City: llc{ SE Luc "e- State:,
Zip Code: Fax:
Phone No �7-2 -SO /- ,Zo33
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail aeVc` ,, hog 1 (0 9v F 490%,00
State or County License PC C
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.
SUPPLIE IIENTALGONSTRUCTISN ILIIEN I MR1 INFORMAM10
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WI YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
I ature of Owner/ Lessee/Contractor as Agent for Owner
ature of Contractor/License Holder
STATE OF FLORI
STATE OF FLORIDA 11
COUNTY OF •�UC',IF.
COUNTYC .�}C•�C',1�
The forgoinstrument was acknowledge before me
The fo going instrument was acknowledge before me
this day of 20 M by
this day of-�� 20y
r
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ident ' n {�
Type of Identific ' S
Produced (_ D
I
a�—
Produced L�
(Signature of Notary Pu lic- State of Florida)
(Signature of Notary P "c- State of florida )
""""' KAI
Commission No. �? IELSEN
Commission No. °'° sY°`''':StaKe of��� NIELSEN
s° f:=State of Florio! -Notary Public
- _ Commission
=• .- orida-Notar y Pubpc
Commission
=y # GG 207484
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REVIEW
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DATE
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DATE
COMPLETED
Rev.217/19