HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / I a -%9 • Permit Nu r. [?D7
SCANNED
r„ .< BY REL
® + St. Lucie County
— Building Permit App icationNOv 12 2019
Planning and Development Services Pelnlltting Department Building and CodeRegula[ionDivision DeP ment
2300 Virginia Avenue, Fort Pierce FL 34982 St• LucieCOL
- unty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial q Resl en
PERMIT TYPE: "—DJin 0? Dtio }• — CT ?��sii" �i, nY A-4-�
Address: C�
Property Tax ID
Site Plan Name:
Project Name: _
) on
k,.
Lot No. I N
Block No.
Additional work to be performed under this per -check afl thatapy:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: OD Sq. Ft. of First Floor:
Cost of Construction: $ 0 % t iti Sewer Septic Building Height:
OW_ iVER/LESSEE � µ
FACTOR _
Name �J
Name:
Address: 10, JbO /% A& D
Company:
rr''
City: Statep
Zip Code:3M(5c91 Fax:
Phone No. 7 a % 1 ',5-
Address: 4
City: State:_
Zip Code: Fax:
Phone No
E-Mail•-SSN I IVkro "A4400 , (DWI
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
;-
UD �NFQRMATION
SUPPCEIVIENTAL CONSTRUCTION LIEN LAAl
DESIGNER/ENGINEER: _
Name—MOmA-s l3 OL
Not Applicable
49,
MORTGAGE COMPANY:
Name:
_ Not Applicable
*Address:. Wr
p V
Address:
City:O-6 Li
ip:3a7 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 Count yy 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
WH-H YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
J
.Signatar;O.y'nef/ L see/Contractor s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument w• �s acknowledgef�before me
A/ P
The forgoing instrument was acknowledged before me
this_day of • , 20/7-by
this day of , 20 by
�'he�Ic �Cf�keJl
Name of person making statement.
Name of person making statement.
Personally Kin OR Produced Identification "
Personally Known OR Produced Identification
Type of Identi Ca
Type of Identification
Produced I L
Produced
,4A1r&4L"
Nobiry Public- State Florida
Public- State Florida
(Signature of of
(Signature of Notary of )
Commission No. I .' "?.""•-. AUDRE%a4yMPHREY
Commission No. (Seal)
1111' COMMISSION N GG 300817
EXPIRES: March 6, 2023
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
IT -
RECEIVED
DATE
COMPLETED
Rev. 2/ // 19