HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ys Permit Number: NcVt sr., 1
SCANNED RECEIVED
St. Lucie County
Man - MAY 14 2019
- -- Building Permit Applicatio
Planning and Development Services ST_kNcta Caunry, permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED
INPROUEMENT LOCATION:
Address: i N N ao'at, c_ _ oc Ou
PropertyTaxlD#: ?�y1��'S3d�G\`�3"�d0`� Lot No.
q
Site Plan Name: Block No. I
Project Name:
DETAILED DESCRIPTION OF WORK:.
�'x-z).C�
CONSTRUCTION INFORM TION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters. —Windows/Doors
_ Electric _ Plumbing Sprinklers _ Generator _Roof Pitch`
Total Sq. Ft of Construction: � Sq. Ft. of First Floor:
Cost of Construction: $ '� �� Utilities: _ Sewer _ Septic Building Height:
OWNS /LESSEE:
CONTRACTOR:
Name eCci I ccc�—
Name: =�
Address: cau�
Company:
City: �SL wc�r State:
Zip Coc!0��� � Fax:
Address: SGv+�e
City: State:_
Phone NoT� 2 Zo2 -7
Zip Code: Fax:
E-Mail:
Phone No
_
Fill in fee simple Title o der on nexepage ( if different
E-Mail
from the Owner listed above)
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.
FIRM REM ENTALCONSTRUCTION U M INFOR
ATE
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 Appl ble
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City: ,i'"'
City:
Zip: i 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordine your, Notice of Commencement.
Signa1yrr_a Own / Les /Contr/ for t for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S-ky
COUNTY OF
The fo[going instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of May 20� by
this _day of .20_ by
13 \a
Name of person making statement.
Name of pe!sgn inai(ing_statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentiG tion
Type of Identification
Produced `� ��—
Produced
(Signature of Nota1 ltlipState ofvEfolNtl RiecvENs
•'• ON
(Signature of Notary Public -State of Florida )
'�°` `_ MY COMMISS #GG 022023
-o-- ExPIRES�D ber 16, 2026
Commission No. jJ'>��uhiicundertriters
Commission No. (Seal)
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FRONT
ZONING
SUPERVISOR
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DATE
RECEIVED
DATE
COMPLETED
Rev. y/2b/18