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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: � 9 SCANNED Permit Number: I BY St. Lucie Countv _ -- �- - Building Permit Applicatio t�Gv o 1 2019 Planning and Development Services Building and Code Regulation Division ST. Ludie Coun errr 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMITTYPE: ( -Akr, `► 1\p Address: r) -�©nten,Jei A-U-e- Property Tax ID #: _3 y0 - t (K - Goo C/- - I- Lot No. Site Plan Name: Project Name: Additional work to be performed under this per - check all that apply: _Mechanical _Gas Tank _Gas Piping _ Shutters _Electric %Plumbing - %`Sprinklers _Generator\ Total Sq. Ft of Construction: 00 Cost of Construction: $ Sq. Ft. of First Floor: Block No. Windows/Doors -Roof - Pitch' Utilities: _Sewer _Septic Building Height: OWNER/LE5SEE: Name {A-GLOlaS -ruL": 0 CONTRACTOR: Name: Address: 57C�3� D(e4n� e Company: Q<y\ City: rorkF /::p�c �••Staie:Pt- Zip Code 49:i3 Fax: 1 Phone No Address '73i 5-o- G� �k - CJ City. �r'(, Zip Code: kOcIRBCs. , Phone No "_ii (- Cuc!e State:",�"c Faz. - E-Mail: .., .— "- Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail & -C/l P State or County License CSC !k� g o5 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. SUPP �M - TAL CON=U DESIGNER/ENGINEER:. Name: 10N N LAW INFOR _ Not Applicable ION: MORTGAGE COMPANY: Name: _;Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: 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." Signature of Contractor/License Holder Signature of Lessee/Contractor as Agent for Owner STATE OF FLORIDA ��1C�IF. STATE OF FLORIDA COUNTYOF COUNTY OF The forgoing instrum nt was acknowledged efore me this �dayof ou "20LIby The forgoing instrume t was acknowledge efore me this�dayof "19V. ,20�by Arn S)Lev / Dr. WLZI rrl.o (e y A p P •Name of person making statement. Name of person makirfg statement. / Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification Type of Identif Produced i Type of Identifi'ca ' Produced _ �Q6-11 (SignaturrF 'Public-State of Florida (Signat a of otar Public -State of Florida I Commissi KAREN 5. NIELLS$E.N da-Nott<r}ea blic Commi o"';$%,KAREN S.NIELSp� f{l¢ °�°- otary rida-NIELCommission # GG 207484 - •_ Commission # GG 207484 M Commission Ex Ires �% ec my 11, w, Jui a 12, 2022 Juine 12, 2022 REVIEW ERVISOR PLANS ANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. Z///19