HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q Q n , 1 I �, ^
Date:SCANNED Permit Number: 1 to I ' ( 1 V ��(J
Erl%`tlll -RECEIVED -
!C� .
fit. LudePCounty I It
SEP 2 3 2019
Building Permit Applicati n ��P �i Sul j f
Planning and Development Services ' ST. Lucie Co_un /, permitting
Building and Code Regulation Division - -" - - - - - -
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)-462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: She
-PRt7Pl)SOhUUIPRCWFMFNT'(hi7ATIhIU-,
Address:
Property Tax ID #: 13o /- 66g- UO3q-000 - O Lot No. S •t6
Site Plan Name: Block No. 89
Project Name:
/V ° Co n come k, !' a e Iccfrr't
,CONSTRt1GTIOtJ INFORMATION` '
s ,
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: IDO
Cost of Construction: $ a a oo.
_ Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof Pitch
Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE: 3 •r
CONTRACTOR T;•; M x,
Name �rian b. Gm Ov't
Name:
Address: QL c,f ra r D
Company:
city: -Et Pierce State: F (
Zip Code: 3Lf q 5 ( Fax:
Phone No. -71 a
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail PIaA d ''o,..
oaf n4 et I - C a rri
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
It 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:WFORM' ATION
., ..
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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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Si ature Owner/ Lessee/Contracto as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTYOF LL)C��
COUNTYOF
The r oing instru ent s acknowledge efore me
The forgoing instrument was acknowledged before me
thi day of 20by
this _ day of 20_ by
121 la hI 0 rv,�
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification `"
Personally Known OR Produced Identification
Type of Identifir. 'o
Type of Identification
Produced �-
I
Produced
(Signature of 1 „ ,
(Signature of Notary Public -State of Florida )
`o �•�G�,, KAREN S. NIELSEN
�' State of Floridakry
Commission N - Public
fission GG
Commission No. (Seal)
as 207484
nun
9'.., o° My Commission Expires
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Rev. 2171.0