HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
2Date: - 2-5 - / % Permit Number:
SLABYN�
St. LucieCeun@y
Building Permit Ap
JUL 25'2019
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 Residential
PERMITTYPE: p��ovn Sctt� n rio�m
Address:
PropertyTax ID #:
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' A _Sprinklers _ Generator
Lot No.
Block No.
Windows/Doors
Roof
n 1 7
Total Sq. Ft of Construction: ��l/ dd�Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
Pitch
OWNER/LE-SSEE:
Name 2
CONTRACTOR:
Name:
Address: i-lam �W ey W� 1
Company:
City: 17�-f S� L� �� State:_
Zip Code: 3 q 9 S-Z� Fax:
Phone No. 5-7 D Zi 3 `S 4� 3 -2-
Address:
City: S-�u
Zip Code: 3qT`c�Fax:
Phone No 7 7q2-- Ic—& Z
State: y
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ,�l+v�
�i / 1 D
State or County License C de f 1
Zi
O
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.
\1
S PPLEME TA GO�N. TRU ION a -N 'W NFORM' TION:
DESIGNER /EN�GI ER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: T/. r-c L C__ Name:'
Address: 3 Yv. ' o4-rc\ 't Address:
City: State: City:. State:
Zip: 33!2 9�2J Phone 5 7 8U 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 holderto 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 ATTQRNEY BEFORE RECORDING YOUR NOTICE OF OMM EMENT."
Signature of Owner/ Lessed1tontr1ctor as Agent for OwPer`l... .
r5lgdature of 'Contractor/Litege Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `'--• L-00-sue
COUNTY OF 5 k • L���Q
The forgoing instrument was acknowledg before me
The for oing instrumLent was acknowledged before me
20nby
thiSaS day of_ZuX`J 20" by
this�dayof
`i,a"t <r'r'--\ akc,c--'3
�oSoec't SgI\I¢.t,-"s
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 Nota ublic- State �0'� IE IG yENS
(Signature of Notary - IE GUENS k'
)EANNAMNt
4': OM! FISSION $ GG 022
Commission No �"V"� rat' (S F ecember t6.20
„?o ..... ° GG oz<o?.1
' ...!'°�'; OOMI SSION ii
��i� 'mission No.�s $Adl).6er 5'v.20�� 1y
m F)CPIRE )
PME&D
Notary PcD!'°O°de
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tie
- NoUN P�pp�Ordemrilns�a
Bonded'fhry
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/i/1`J