HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED dd
Date: \ \�3` Permit Number: ykD d5
k- _ J� Ii_ „l RECEIVED
N 2 3 1..�J18
Building Permit Appli ati JAN
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Q\ \ a wS
PROPOSED IMPROVEMENT LOCATION:
Address: ,V V U� k)�/�J -
Legal Description:
Property Tax ID#: \ 6 V3 " d� d dd b —� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit ermit—check all that appy:
_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: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name , IA[_- /�� ( .� �)f� Name: W
Address: ba �f Company: � Z w
City: � i r✓Q C (� State:
Address:
Zip Code: Fax: City: im rt,, G State:
Phone No. S g Zip Code: �1 Fax:
E-Mail: Phone No "t J� �
Fill in fee simple Title Holder on next page if different E-Mail
V L
from the Owner listed above) State or County License,R
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 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 clothe 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
ry44N V LO 6 Id 0-A kLt� 46 A A A,/,K
c
Signature of Owner Lessee/ ntract as Agent for Owner Signature of Contractor/LICenS Olde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��'( L� c \e COUNTY OF �-,k
The forgoing instrument was acknowledge before me The for oing instrument was acknowledge before me
thi day of �� 20� by thisa day of q^r\ 20 by
itdV_t\ Lk, -� kl \� i-( -tr '\il1. 1.�W\�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary ublic-State of Florida ) (Signature of Nota ublic-State of Florida)
Personally Known OR Produced Identification s. Personally Known ation
ProduceType of d
NAMp�I_GiVEP:S a Type of I D[ANNAMARIpGiVENS
iJ G`�y�i02, Produced = �a � COMMISSION#GG 022023
MY COMMISSION#aAr 15.2020 + <' EXPIRES:Decem 20 1
Commission No. "`= 1�e cem �ewr:te� t l� tary public undervrtitersPt�bry;'a�r,�` Commissi
Bonded
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEAT TURTLE TLE MANGROVE II
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE J
RECEIVED
DATE
COMPLETED
Rev. 712014