HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP [CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: St I 7,OL� SCANNED Permit Number: I
BY RECEIVED
St. Lucie County
f; LAUG 0 9 2019
Building Permit Applicatioie County, Permitting
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 X
PERMITTYPE:
PROPOSED INPROVEMENT_L0cATION,
Address:
Property TaxID#:Lot No.
Site Plan Name: KAu i ii ns 1 Block No.
1J Project Name: 1 I ILAu� ,mac I IJ
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator X_ Roof Pitch
Total Sq. Ft of Construction: � (9 cgs Sq. Ft. of First Floor: Q CQ % V
Cost of Construction: $ s-)% i ,E) Utilities: —Sewer —Septic Building Height: is
OWNER/LESSEE::-
CONTRACTOR
4 `
Name
Name:
Address:
Company: 'City:
V
1 State: _
Fax:
Phone No.
Address:ZipCode:=
City: ��oYC�i
Zip Code: 3 � O Z- Fax:
Phone No Z
State* EL -
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
i
E-Mail Cn I CC) l ief-fi
State or County License =1
if value of construction is $2500 or more, a RECUKuE0 Notice OT COmmencemcna 6 I aymwa.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.CONSTRUCTION',LIEN ON LAWN INFORMATI=
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:
Zip: Phone: Zip:
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 contlict 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmpnrino work nr rprnrrlinv vnur Nntirp of Cnmmencement_
- XJ
Si a ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLSTATE
e+ I
OF FL S- 1 `UCie,
COUNTY OFORIDA
ucn-ej
COUNTY OFORIDA
The forgoing instrument w s acknowledged -before me
The for oing instr men was acknowled a efore me
by
thisdayof 20by
thisdayof20
S
�X1�T,1
Name owkson making statement.
Name of person making s atement.
^
Personally Known `r OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
i2kC212=�
Produced
Signature o otary Put;1Cikc-,5tate
No.
No,
__
o -
�) E HAVENS
My COMMM��S,,,S,IgQN� #GG166030
f
f-N ary Pub I - tate AT4EPINE HAVENS
oY9YPYa KATHERINE HAVENS :o +��('' 'SS.ON #GG1650Commission
'Issio'nCitlpin,i�e21) •_,,; DEC 04,2021._„� DEC 04,2021
IXPIRC3`�EC 04, 2021Commission
,Bunon,�n•�uughlst
Bonded through lst State Insurance
L EXPIRES:DEC04,2021 Siatelnsu2
Band
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FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev.9/26/18