HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED f (y /��
Date: l r� i ��nn'n,� Permit Number: L"L / I
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:
BY RECEIVED
St. Lucie Co ft
Building Permit ApplicatioJn JUL 2 6 2019
ST. Lucie County, Permitting
Commercial Residential 4—
Address:-
Property Tax ID #: .) 44 a.8, — -�)3I D 00I r) � �Lot No.
Site Plan Name: Block No.
Project Name:
DESCRIPTION OF WORK:
-, '!_ a \ J
CONSTRUCTION INFORMATION:
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:
CosGoT- nstructjon:$� _ l��d -�
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: ,
Name &62�p
Name:
Address: P66 L
Company:
City: 'el State:.
T
Zip Code: ��C/S Q -�Z Fax:
Phone No. % J U fta
Address:
City: State:_
Zip Code: Fax:
Pine No
E-Mail: Z P,.,S A�, oI �� m �C
1
:Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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 CONSTRUCTION LIEN LAW INFORMATION.-
DESIGNER/ENGINEER: _ Not Applicable _-MO
Name:
- RTG ' AGE COMPANY: _ Not Applicable
Nae:
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."
5 �_
Signature ofawner/ Lessee/Contractor as Age t for Owner
Signature of Contractor/License Holder -
STATE OF FLORIDA �
STATE OF FLORIDA
COUNTY OF c k U AS
COUNTY OF
The fa nowledg efore me
this of d 20by
The forgoing instrument was acknowledged before me
this day of 20 by
_
Name of person making statement. S
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
A
V v
(Signature of Notary Public-Stat f Florida j
Si nature of Notary Public- State of Florida )
Commission No. (SeaELLEN VAUGH
fission No. (Seal)
iu •�a%'�-State of Florida- Notary
N GG 27
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- •= Commission
•�?av�P� yg
16bW 221 20
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REVIEWS
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VEGETATION
SEATURTLE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ // i`o