HomeMy WebLinkAboutBuilding Permit Application ,
MUST BE C•PLETED FOR APPLICATION TO BE ACCEPD
All APPLICABLE INFO .
Date: Permit Number: IP5 • 0 3'7?
iii
i T ._ RE®
. F L C> R 9 Q R. MAY 11 2019
Building Permit Application Perm,ttlp9De.
Planning.and Development Services St' Lucie Coar ent
nty
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:
PROPOSE® I'NR®VEMENT:LOCATIQN:y .:r.,. , ,•. .. ., . _ 1-.. . ..:.. . , . ;...
Address: -k 1 -eA - \e S .c c
Legal Description: H idd 'r -V t A�PS F Si-th2S M LOA" 12 Cl.c» • c\ (6`� 3y12-1��17,
Property Tax ID#: Z32. 3-7c1- e(Q-150b-7. Lot No. ID-
Site
aSite Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
TAILED D _SCRlPTION F W®RFK '144-,.:.`.,.,,,,-,...,::q;: 4.:.?
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Additional wd k 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: $ (D tD 0-6 Utilities: _Sewer _Septic Building Height:
-OWN! R/LEZSEaE , e z gR C®NTRACT®R: -1- .
.
Name F t,oi(1Ct tt 'kcry.0 aki "�11 Name:
Address: o [t f 68-en feints 12-C1 Company:
City: 4)E,e('et_ State:rt., Address: _
Zip Code: 3C QL(Sj Fax: City: State:
Phone No.77 2 1466 2t, 4' Zip Code: Fax:
E-Mail: L�mpi*Defy L bt 1) C kla bO.L. Th Phone No
Fill in fee simple Ie HoldeF on next pagel ( if different E-Mail •
from the Owner listed above) State or County License
1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S �..... •
SUPPL MENTAL 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 recording your Notice of Commencement.
711
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6N.A3s, COUNTY OF
The forgoing instrument was acknowledge91 before me The forgoing instrument was acknowledged before me
this day of tes l , 20 V% by this day of , 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ic-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced -t. 6 Produced •
rasit4 MARIE GIVENS
Commission No. W-4 ties �t t GG 022023 a Commission No. (Seal)
MY CM
mem
Notaro bet 16,2020
EXPIRES:D public Unaenvr tern
io? 6�nd�dl'n u
REVIEWS FRN ¢`' NTNG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW • REVIEW ,REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 7/2014