HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� n
Date: 3 SCANNED Permit Number: �qO'1' ujgo`ii
BY
St. Lucie County RECENED
• JUL19 2019
Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: 0 /_ -1- ' .4
Property Tax ID 6 26- �, yaai - //3-dllo/- O!O -�i Lot No.
Site Plan Name: Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
X Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ � %5'OD. Qp
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE-: s. +;
GONTRACTORk
Name
Name: KtA-
Addre s: GOo 9an 1P.i. Q (Aomw_ d
Peo/y
Company;
City: t=A944 y A9 State: _
Zip Code: / 5.2 / A Fax:
Phone No.
Address:4?#3 Lim
City: tOtie.��
Zip Code:.3A19'15 Fax:
Phone No 370-4-FO
State:. L
S=6/-.777 7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MaiIM r KeO midi. o j&-4J'h%
erjt. C o M
State or County License E d /300-5
4e
S'5 9
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
Name:
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
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, 1 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/ATE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO 9ATAIN FINANCING, CONSULT
WITH YOUR LENDER ORIAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
JQA�
"�2u
-
Signature of Owner/ ssee/Contractor as Agent for Owner
Signatuffer6f Contractor/ cense Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF 5-[Ajc.e,
COUNTYOF S LLIGC
The for oing instr�nt was acknowledged before me
The forgoing instrument was acknowledged before me
this jMday of `) uk.n_ 20A by
this � dlay of VV1J_ 20A by
Q�1
�I�iC�u-t ��irX�.
rCV1.� Yirl)—
Name of person making statement.
Name of person making statement.
Personally Known __ZOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
uced
P uced
ature of Notary Public- State of Florida )
(Signature of Notary Public- S ate of FloridWAX&ah
NOTARYP
Commission No. CGIAk—I05o2_STATE OF
U
L@Mission No. C'��0Z�1DS°2 DavidRayrnom
ommp GG
4141
87052 NOTARYPUB
12023 =STATE OF FIL
, Comrrdf GGZ
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ZONING
SUPERVISOR
PLANS
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SEATURT
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COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19