HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
COUNTY
F L O R 1 D A
Permit Number: 19 Ori • d
RECEIVED
FEB 2 0 7018
Building Permit Application
and Development permitting Departure
Planning P St. Lurie Countv
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5V 6 6 3 uAtiszf -8 i v J, fpr t C �i�C1L_ L, 3 Lfc(:gZ
Legal Description:
()At;f-nst_
2
Property Tax ID #: :3 � 0 2 -(nd q _(06 20 - QC1 d -- 2_ Lot No. 2 -
Site
Site Plan Name: Block No. T
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I
►�� N :� 0 e -W (Yl � u� er_ barn (�1 cel -e r Mei e�
beck ori haus e , N 4P j ►�c,l Ye
'v >��Se 10 b ro he rA,s*Ae_A ,
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit - check all that appy:
HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers a Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
dr
Cost of Construction: $ Utilities: _ Sewer O Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t 2 (-
Name: 2 1
Address: LL 76 El A WC, STR�E^f'
City: 11 E N SC -2)F A CH State: FL
Zip Code: 3 HQ5 7 Fax:
Phone No. 7 7 2 -631-
E -Mail: (�(-ra_C,4 N Afrno" . �Nt
Company: ac_
Address: 2_79 V -A-e
City: 14, P-, e -r cp- State: F -L
Zip Code: 3qq�; ( Fax:
Phone No 772 -S-79 -2--t62-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: W e.((,t,U' Drt , j2/L
.J,)y4 (!C®Ct-b/. COM
State or County License: C
'C l LJ2-g g 15
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature o/ Owner/ Lessee/Contractor as Agent for Owner
se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-f LCOUNTY OF S± L,) c-,\,
The forgoing instrument was acknowledged before meI The forgoing instrument was acknowledged before me
this 2 U day of 6.617 20� by this day of j�6) , 202_J� by
f -f 2�.s.r, e-// S1+-556 f f I I{«9r,4W9s e ( i 0S/>,s,5e1-4'
Wme of person making statement NaMe of person making statement
Personally Known OR Produced Identification ;;4 Personally Known OR Produced Identification -Z-
Type of Identification Type of Identification
Produced Produced ..
ure of Notary Public -
of Florida (Si nature of Nota Public- State of lorida
g Notary ) �
Commission No.
(Seal)
Commission No. 1--ussV AiVION to '"N 4 u09
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17