HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number: 19OR im
Date: l
SCANNED RECEIVED
BY
s St. Lucie County AllG'05 2019
Building Permit Applicatio'nmitting Department
Sr, Lucie County
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 Residential
PERMIT TYPE:
PROPOSED
IMPROVEMENT LOCATION:
Address: . zop'a 5,. A
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DET+AILED DESCRIPTION OF WORK:
fY1
CONST T � I � N NFOR f AT ON'
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors
Electric Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: e�ewer _Septic Building Height:
OWNER/LE-SSEE:
CONTRACTOR:
Name
Name: ` SC
Address: �y SgcewA-.Oy �
Company:
City!t/(n4(/ _da?al /i/_3tkw))-State:
Address: ." -
City: " ' State:_
Zip Code: W Fax:
Phone No. !
Zip Code: , = Fax:
E-Mail:
Phone No '
Fill in fe i ple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
U PME T 11% GN 51&RU
DESIGNER/ENGINEER:
Name:
10 I W I
_ Not Applicable
FO O
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address: `
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count .makes no representatibfrthat is granting a Permit will authorize the permit holder to build the subject structure
.whfeh.i, niconryct�with.aryy,applica le,l{omeCJwnerrAssoaatfd'nsules,by(awstoc,antlCqvenants,tbat-mayresthztX6rprohibitsuch
sttuciore>•Ptease cb�gdR'with your a Owners Association anti re0iew your de2$for'any �esfricticins wh`fchAay�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,feview: room additions,
accessory structures, swimming pools, fences, walls, signs, screen roamsand•acyelso' sesto anottig -pori,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
crWITH; R LENbEA?OR�A1N ArTxilik' BEFORE4WtORDINC•YOliR111Ufi1GE•OFICOMMENCEMENT:I::•� c -�
1'i-l., 1f` ,`sj'4i` 'v�:•� .{�:1 �. .`1'•'.i•: �,;1 •\�ls'�t_l �}�'�,4
;•. � 1,v^�\•�:,3�` 1 \\`�l 1� ';_i\14• i_?',
SignatuV.of- w r/ Lessee/Contractor as Agent fordw-ffor
Signature of Contractor/Llcense'Holdet
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr ent was acknowledge me
The forgoing instrument was acknowledged before me
this `c720L by
this day of 20 by
���,�•�, � a to Q.'.�,,,o.��
_ •,.
Name of person making statement.
- Name of person making statement. -
Personally Known OR Produced Identification -
Personally Known . .:OR, Produced Identification
Type of Identification .;
Type of Identification" t
Produced. _.
Produced
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(Signature of Notary Public- tate of Florida)
(Signature btNotary Public- S OatP;:P.fyFlorida :,.,�`•
Commission No..,"''� RARMING
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-'�'' ...-`C:! s �� y ,lJsj�c:(Sea�)�';•".�'
Commission No, ,
C,:?•. MY COMMISSION 11
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---REVIENP
- REVIEW
DATE
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RECEIVED
DATE
COMPLETED
Rev. 2/7/19