HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONF
All APPLICABLE INFO MUST BECOMPLETEDFOR APPLICATION TO BE ACCEPTED 7
Date: �7. Permit Number: �q'10�' 13 � ,y�p
SCANNED
A StIudeCou*
L!EEIVED
--- Building Permit Appli2019
Planning and Development Services
Building and Code Regulation Division epartment
2300 VirginiaAvenue, Fort Pierce FL 34982Phone:(772)462-1553 Fax:(772)462-1578 Commercial untyr FL
PERMIT TYPE: O �n�
PROPOSEOIMPROUEMENTLOGAT/�•
Ip cv 10 A51- r/ t3 4sa
Address: J- D /<
Property Tax ID #: D — Lot No.
Site Plan Name: Block No.
Project Name: � J V i64e vt-t av
K.
DETA[LED DEfiGRiPTION OF WORgo
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CONST UCH ION INFORMATION: - -
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors
Elect r 0 b Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft df Construction: tn�"r x 5� Sq. Ft. of First Floor: , 1
Cost of Construction:$ / 'D� Utilities: - Sewer _Septic Building Height:
OWNER/LESSEE'
GO TRACTOR:
Name rl a t-allis0
Name:
Address:a37`?i () V ✓ 12(,Y)I n
Company: Yb IV) 04- Of
City:4?Dr4:St L U(1 5tate'11-�
7'
Zip Code: c3� Q s Fax: ! r c
Phone No. Z ?a- .2h �— 7�g"
1CCY
Address I G' >^o � � c l�
i YYLI L
City .'I 1 6.F150 n.. State:,
Zip Code, �(� 1 / Fax: >�
Phone�No=� 7 A -- -ybo 0 - � &OO
14I
E-Mail: C(� C'�l�lh %j eq 0 BP�/.wA. n�"'
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement isaequired.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEME
T L WNISTRATCoffifigrd LIEN W INEORMATIO
DESIGNER/
Name:
NGINEER:
S
N t 99pplicable
ZC
MORTGAGE COMPANY: _ Not Applicable
Name:
Addres : ,. (r
>
IJ t cv C
Address:
City: et tV!
.Zip:
Phone
Stater ,
City: State:
Zip: Phone:
-FEE-SIMPLETITLE-H OLDER- —
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City: I
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,-,
igns, 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 Owner/ Less e/ ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA '
COUNTY OF
COUNTY OF
The for oing instru nt was acknowledged -before me
The forgoing instrument was acknowledged before me
this day of 20 //_hh�� by
this day of 20_ by
_e en
Name of person making statement.
Name of person making statement. ,
Personall wn OR Produced Identification
Personally Known OR Produced Identification
Typeof Identi ' tin
Type of Identification
Produced
Produced
(Signature of o ary Public- ate of Florida Y U
(Signature of Notary Public �StaeofFlorida )., -. -
Commission No. ?'.,"'Seal) AUDREYB.HUMPH
EWom sion No. '�.; (Seal)
My COMMISSION#GG
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Pi FS- March 5
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Kev. 211119