HomeMy WebLinkAboutBUILDING PERMIT APPLIACTIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `\NI %�. %
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
P o�(772)462-1553 Fax:(772)462-1578
PERMIT TYPE:
4-
Address:
SGANND Permit Number: `g01' C M
BY RECEIVED
St. Lucie Coantit
Building Permit ApplicationSEP 13 2019
ST. Lucie County, Permitting
Commercial Residential
Property Tax ID #: 332/ —9'OS no(b —00' ( Lot No. 5-1
Site Plan Name: // Block o�Z�O�
Project Name: TVf dl/l
Additionalworktobeperformed underthispermit— checkallthatapply:
_Mechanical _Gas Tank _Gas Piping _Shutters �Windows/Do`ors
_Electric _Plum�
Plumbing _Sprinklers _Generator '� Roof Z /Pitch
Total S Ft of Construction: �J �� S�
q. >> q. Ft. of First Floor:
Cost of Construction: $ ?i! �lJ� Utilities: —Sewer Septic Building Height:
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Name C �2gi �f flz
Name: t p.
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Company: !I!dn!, riaCl2.
City: Q/L State=
Zip Code: r .yF�ax J " ' e : �)
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Phone No.
Address: ` + 2 �! I !!G ` J. i
City: � a•� ,, .StatBi .
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Zip Code: ?Yfo / G ._Eax:.
Phone No
.E-Mail.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail /a ,Q/3",Qrbi%S~foga ed t Gd/y
State or County License sec.132 0�34:9
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. -31
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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Not Applicable
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FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING •MPANY:
—Not Applicable
Name:
Name:
Address:
Address:
City:
city:
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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
Trnnucv nccnor orrnornmr yin to ur1TIrF nF rnMMFNCEMENT "
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Signature oKontractor/Li ens('e� HolderSTATE
Signature Owner/ Lessee/Contractor as Agent for Owner
of
.
STATE OFFLORI*/ % GfLC/
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COUNTY OF %o `'/
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The fo ing instrum t w s a owledge efore me
The for ing instru ent was cknowledged fore me
this�dayof�20"by
this�dayof�20"by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification/
Personally Known v OR Produced Identification
Type of Identifi . tipn
Type of Identification
Produced /'1//
Produc d
(Signat
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EXPIRES pri112.2021
EXPIRESApril12. 2021
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DATE
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DATE
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Rev. 2///19