HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)AIVAPPLICABLE INFO MUST BE CO
Date: / ). I c)US• 1/ JI
FOR APPLICATION TO BE ACCEPTED
Permit
SCANNED
BY
St. Lucie Countv
Building Permit Appli
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE: e D v w I (D l)
PROPOSED IMPROVEMENT LOCATION:
Address: 776 3 f /l (6 & 4 A gr
Property Tax ID #:
Site Plan Name:
Project Name:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
io
��f
li a. ,... �,��-
NOV 14 2019
ion
ermitting Department
St. Lucie County, FL
Residential
Lot No. 3
Block No. Z6
Windows/Doors
Electric Plumbing Sprinklers _Generator Roof !�=i Pitch
( C.
Total Sq. Ft of Construction: f u'K9 On -c I `i (ia Sq. Ft. of First Floor: e o" L <o. r/ 1 ?6�
Cost of Construction: $ t7 j S 6 00 Utilities: —Sewer _Septic Building Height: —� FO012.
OWNER/LESSEE:
CONTRACTOR:
Name a6 M 14a N Pz
Name:
Address: 77 6 3 Pld/orr, //Q 5 f
Company: /2 a/ G ✓{
City: piel^Ce- State:
Zip Code: F 9 S� Fax:
Phone No. 3D S I /'/54/
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: Ila4tLeg 16e, 2-63 Q YA tnn . L' t
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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
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"
ignafu�e:dfOwrterWee/CoNIZIC.tor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID A//���'
STATE OF FLOR16A
COUNTY OF o
COUNTY OF
The forgoing instrument was acknowledged before me
�% 11 A by
The forgoing instrumentwas acknowledged before me
day 20_ by
this • day of f • 20
this _ of
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific '" /�
Type of Identification
Produced '.itn t
Produced
i
(Signature of N It ' -
(Signature of Notary Public -State of Florida )
.�:P§,, AUOREYB.HUMPH 3�617
Commission N .= , ,&, ,Y": P�ry i:�MMISSIOK999)
Commission No. (Seal)
`w= f� ` EXPIRES: March 6, 2023
=+e;° Nab Pu6lie Undters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.