HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C� Lip tJOS Permit Number:
C&N • irIJM low
Building Permit Application SCANNED
Planning and Development Services BY
Building and Code Regulation Division St. LUCl�iity
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: I DL Ave S
3// p
Property Tax ID #: 412yo s — l2Q T — OC)& � —4260 —� Lot No. [lpyh l9
Site Plan Name: , Block No. 3
Project Name: Mrs 1',
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _Shutters / windows/Doors
P,' r1ectric _ lumbmg _Sprinklers _Generator oaf Pitch
Total Sq. Ft of Construction: I % D� Sq. Ft. of First Floor:
Cost of Construction: $ �190� Oor) Utilities: _ Sewer _ Septic Building Height: 10�
Name t4_JVd,, W ilr.W it ^j.r . Name: 5O il) C P
Address: ITO5 Company: (�'eorar'41 SDGaltS /16
City: FT. 19, P Pe c State: Address: -:355D QKe e Jk ofiee e Q
Zip Code: 1 f7 Fax: City: F I • Pr erez Stater
Phone No. go g— yQ V —,25-6 3 Zip Code:., It-94/'7 lD Fax:
E-Mail: Phone No 772- a'311 ?0D
Fill in fee simple Title Holder on next page (if different E-Mail i k I from the Owner listed above) State or County License t,4 / si 3 &
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.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: n State: City:
Zip: go Phone -51 - 72 Zip: Phone:.
Not Applicable
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Address: I Address:
City: City:
Zip: - - - Phone: -- - - _ Zip: - - - Phone: f
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 areexempt 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 JQQB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND O OBTAIN FINANCING, CONSULT
WITH YOUR LEND,EIN OR -AN ATTORNEY BEFORE RECORDING YOUR NOTICE COMMENCEMENT."
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Signature of ner/ L see/Contractor as A nt for Owner
Signature of C ense Holder
STATE OF FLORIDA/
OF St%uGr
STATE OF FLORIDAU //
COUNTYOF 51f 1C,g,1'e_
COUNTY
The for?oing instrument was acknowledged before me
The forrG.oing instrument was acknowledged before me
this � day of 20_a by
this L day of,}t/1. / 20J j by
Name of person making statement.
Name of person making statement.
Personally Known �-� OR Produced Identification
Personally Known O� R Produced Identification
Type of Identification
Type of Identification
Produced
Produce
,28'7i 1, /.i J
(Signature of Notary Public -State of Florida) -
(Signature of Notary Public -State of Florida )
Commission No.NAPYNdery Pudic Fbrida
'
Commissi '3�" Notary Public State of F14fma I)
Hams
� pia ams
MY Commission GG 238873
Nly Commission GG 238873
REVIEWS
VhAOR
PLANS V A
ANGROVE
RO
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
Rev. 2/7/19