HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTeo
Date:512M I I CA Permit Number:
SCANNED
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Residential
MAY 2 9 2019
ST. Lucie County, Permitting
Iu
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: Lot No.
Site Plan Name: p� 1� p Block No.
Project Name:onno l_,1 / /l l
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 Constructio
Cost of Construction: $ O
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
)C K)
Name:
U
Adr
LJCG
Company:
ci- ty:
Zip Code: tt 'Fax:
. -) �GS'�_
Phone No��.I
Stated
•'
`
Addre '-.S._�
City:'
Zip Code:
Phone No - -
C.. i C l a State: r
Fax:
�( •� LVI
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ret�
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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.
SUPPLEMENTAL GONSTRU I IEN LAW INFORMATION:
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
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN. FINANCING, CONSULT
WITH YOUR LENDER OR AMATTORNEY BEFORE RECORDING YOURINOTICE OF COMMENCEMENT"
Signature of Owner/ Le ee/Contractor as Agent for Owner
Signature of Contractor L' (dense Holder
STATE OF FL RIDA
STATE OF FLORIDA L '!
COUNTY
COUNTY OF
OF 1J 10,16
The r oinginstru w s acknowledge efore me
The f oing instrument was acknowledg efore me
thi day of Q
1 . 20LI by
thi day of 20 , by
`(/��
Name of pe�nlmaking statementU�o
.o
riingtoI W
ame'of person making statement.
/
Personally Known OR Produced ntification I/
Personally Known OR Produced Identification
Type of Identification Produce
Type of Identific itSn
Produced
`
(Signature of Notary Public- State of Florida )
Commission No. o"d:"'••• KAR IR N'IELSEN
+ 1__state of Florida -Notary Public
�e Commission # GG 207484
';;;o���a�,.�'� My Commission Expires
June 12, 2022
(Signature cf Not Pub is -State of Florida)
um�p
Commission No. "w•� •, KAREN(Se IELSEN
a e of Florida- otary Public
= Commission # GG 207484
iy
REVIEWS
••"'M1`O�`
June 12,
022
R
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW;
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
L!v 2/7/19