HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLI96 FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
NI= . et�'1�."�.,M. JUN 13 2019
Permitting Department
Building Permit Application St. Llcie County
SCSI�PIkL
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
PERMITTYPE: J%o%
PROPOSED IMPROVEMENT LOCATION:
Address: A/Iq,,wL4I
BY
St. Lude blunt
Residential X
Property Tax ID#: &7 5- %b/-DOGC? -DUU! Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION IN
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: 3 2 O -c4 Sq. Ft. of First Floor:_
Cost of Construction: $ �./)/%/� Utilities: —Sewer _Septic
Block No.
—Windows/Doors
_ Roof Pitch
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name " fL - aK/
Name: 11AIA,44L
Address:_2- / 4 ,�_ 3 iyP %
Company:,Do✓✓
City: ��; eyLc T State: �
Zip Code: 4��f % �f f'o Fax: 77L -" 7-13+f
Phone No. -2y- 2$- yL
Address: �/ f^ y� �� 19 L, -e-
City: State: l�/
Zip Code: 3 �i� Fax: 27a �G7%3cf
Phone No 772-- `-52-cF- y2 1'17
E-Mail: i ,,,,, A ;h k4 (P � eXa a14 ' &/e,%
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail L,,i ` l e a ut4 -1/'e
State or County License
It 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 CONSTRUCTI'
fN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Own4r Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S�- C /�
STATE OF FLORIDA / -
COUNTY OF �(L((i / 0
The forgoing instrument was acknowledged before me
The for Ding instrume%t was acknowledged before me
this J3day of rr� 204by
this day of ✓-V-P_ . 201' by
(n 1-�vn���
�,n�� 14A nVkk
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 Ft (Q c,
Produced A( .L ,
2 '\ )-ra
F-
(Signature
of Notary Public- Sta a of Florida I
(Signature of Notary Public -State of Florida I
Commissi
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Commissio
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'- Commission # GG 270079
`�o�? VAUGHN
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o;State of Florida -Notary public
Ooto)er
REVIEW
22 2022
PERVISOR
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REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Kev. 217119