HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I�FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: Permit Permit Number:
J 1 Re PRO
Building Permit Application APR 4 2o:s
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division n
2300 Virginia Avenue, Fort Pierce FL 34982 w N J
Phone: (772)462-1553 Fax: (772)462-1578 Commercial L • Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: U U tl S 'A)
Legal Description: � � l eJ,4J -0y �1U
Property Tax ID#: <�S� bu `, UU G G U U C ) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED�DESC�RIPTIO�NOF WORK:
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COSTRUTIONCINFORMATION:
itio workto e orme under
this permit–check a appy:
HVAC
Gas Tank F]Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities:E_Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 'fi:)iMt Name: 'RICI4AfZA Usk-AST
Address: j,�i Mq/LTi/'J LN Company: Co LIA 2EM C- !e/
City: .5 i o Lo M State:— Address: G 3 3 N i I-40/Z Z u Lil/
Zip Code: C) i Fax: City: ? - S - L Stater
Phone No. q IC 0 V_ 7 -4, Zip Code: 3!19 J-,3 Fax:
E-Mail: Phone No. 112,Z L,T7 9, 12�:�J
Fill in fee simple Title Holder on next page(if different E-Mail:�y'2i- K/4(z r.426 VQ(l I L-
from the Owner listed above) State or Count License:
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 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 Cerording your Notice of Commenceme
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Sign atu w4r/lessee/Contractor as Agent for Owner Signature of Contractor/GHolder
STATE OF FLO DSA STATE OF FLO��tIDA
COUNTY OF _ L`1e%e COUNTY OF �-. wc'\e
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
thisa�day of q Q i \ 20]� by this�day of Q p c.� 20_�J_ by
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
Produced VL )D L Produced 1 t) L.
UtdEi+6--��
(Signature of Notary Pub c-State of Flor ,� � (Signature of N ry.Public-State of FloriC� GG 022023
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-f�' h1�SR1E GIVE6+a I.,
; ce her 16,2020
Commission No.L �S�T�a:�k MYC XON#GG 02202` Commission No d EXPIR. derwnle{
?a? EXPIRES December 16,2020 II F °', Thm Notary i
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79 o- Not3n'r
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17