HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C IVWLETED FOR APPLICATION TO BE'ACCEPTTD
Date: 7I301(5 RECEIVED SCANNE t Number: - 5
JUL31 2019 St. BY
Lucie
CDunf
_ ST. Lucie C n ittin y M
Phone:pnj •D
ermit Applicationr
Planning and Development Services
Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residential
PERMITTYPE:
PROPOSED IM ROVEMENT LOCATION:
Address: VS.Z P,S.C. F-L. 345 2-
Property xID#: (`1YJ;kA\%Nu D-6�- a- Lot No.
Site Plan Name: 1 ` - Block No.
Project Name: t �t (- `�- GCs,l`k
DETAILED,DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: T��
Cost of Construction: $ lid®
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name bf-t- S Lu6c- P,a Z-,=
Name: LQ u nC
Address: II?-- Pl\y[ivc C7-
Company:
City: _r-(INOA N I State:_
Zip Code: / /003 Fax:
Phone No.
Address:3(I��� �Jer l
City: P• S •(- • State:hC.
Zip Code: 3u(cfif) Fax: -77P-- 2�3-6?&S
Phone No i7k IS'-297`f
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
c
State or County License CiiL` Ia S(.Ofo {
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.
Z,L. *- /%e-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:_
Zip: Phone:
Zip:
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 1,ENq€R OR AN ATTORNEY BEFORE RECORDING YOUR NOTI"F COMMENCEMENT.'
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I
Signature of Owner/ -e see/Contractor as Agent for Owner
Signature of Contra c
icense Holder -
STATE OFFLORI
STATE OF
1
COUNTY OF �VC.IF.
COUNTY
xcl
The f r oing instr ri nt was acknowledge efore me
by
The f rgoing instr rrnt was acknowledge before me
1 by
this d1ay of 20
this of
20
1�
` \
1 IAEV \�.)'Ir"kr'�
F�1 `day
\A 1ig1."e-r
1��,��' mrj
b�
Name of person making statement.
Name of person making
statement.
Personally Known OR Produced Identification t/
Personally Known
OR Produced Identification
Type of Identif
Type of Identificatio
Produced I L
Produced
(Signature of
' S13ta
(Signature of NotaryP
h"A RFAR
„`"'o KAREN S. NIELSEN
PY GL //i
o"v' KAREN S. NIELSEN
�� `��=State
Commission N
�z°�� ��/ State of Florida-gly Public
Commission No.
of �g�l�q Notary Public
_ �` ommission H G 2 7484
- tr Commission k GG 207464
M Commission Expires
My Commission Expires
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REVIEWS
SUPERVISOR
PLANS
VEGETATION
FRONT
ZONING
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19