HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: l'rv- f,"n1fl'� Permit Number: 1Q 0q wpa
bRe®es9 RECEIVED
BY SFP 0 5 2019
St. Lurip fhRnPv
-= rnitting Department
- �- Building Permit Application '-''Cie County
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: �(
PROPOSED IMPROVEME
Address:
Property Tax ID#: )y3a-a`� 013ol— oC)Q/2 Lot No.
Site Plan Name: Block No.
Project Name: 1pvr'S� � A-<
DETAILED DESCRIPTION OF WORK:
71; sVn\A -Very e_ Qe.r- Ptc, S
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ XWO
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
-Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name P,,e..,V .1<
Name: ,\ G L�oc3
a Jr
1
Address _3Rgi �o Ca,cn� b6L
Company: it ,,kw
City: �;2,� Pie"te ?Ek., State: FL
Zip Code: gq` '0 Fax: zt,6l $ 1- 37s `;
Phone No.-f7t 379 635'2
Address: P X),
City: r, 2)a�
Zip Code: 33t tOs
Phone Nof6l- 833-3 7S
State:_S:_�
Fax: _s61 833 ti7 41
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License EL
13 6074q 1,
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
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:'
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Siguaturevof Owner/ besaee/pltractft As Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
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COUNTYOF
The forgo instr ent
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The fo oing instru ent w acknowledge efore me
thhis(-dayof
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Name of per on making statement.
Name of person making statement.
Personally Known
OR Produced Identification t1
Personally Known OR Produced Identification
Type of Ident ' 'on
Type of Identificati q
Produced
Produced l_
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(Signature of Notary Pub'
(Signature of Notary Public- State of Florida j
KAREN S. NIELSEN
;��=Stata�orida-Notary Publi
Commission No.
ommission Na. ,` ^ •,, KFkBEtV S. NIELSEN
Stat�'�?`lorida-Notary Publ
_ Commission q GG 207484
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-'-• •; Commission s GG 20748
My Commission Expires
u
e 12, 2022
J
ne 12, 2022
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