HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _Z 4-' Permit Number:
RECEIVt=U '�qR
Building Permit Applica ion '��,�,n9 ?o/a
Planning and Development Services MAY 3 0 201$
Building and Code Regulation Division
ST Lucie Co
2300 Virginia Avenue, Fort Pierce FL 34982 Lunty, Permi mg
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ( a
PROPOSED IMPROVEMENT LOCATION:
Address: C6 1 1 i rV6, Ivve.
r^` f f J� 3
Legal Description: �� V i.J Y� n I C 1 L ( l l ll'L.
Property Tax ID#:tt L t'! `— Lot No.
Site Plan Name: klaa yei Block No.
Project Name: NACU + k'-
Setbacks
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nertormed under t ispermit—check all apply:
HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:nSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name p Nam'Q
Address:D 0 C I '� Company: d-
City: lP ri e— State: Address: CJ_1 a- V)'yPP7fiVOC)d CJ) !
Zip Code: Falx: City: State:
Phone No. D l 3 J 1 lqolia Zip Code: Fax: c�
E-Mail: Phone No. DL Le0
Fill in fee simple Title Holder on next page(if different E-Mail: er 4i d r `!. C (Yl(�-4 ( • CC(Y)
from the Owner listed above) State or County License. '( y
Lf 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 recording our Notice of Commencement.
Signa ure of Owner/Le ee/Contractor as Agent for Owner Si nature of Contractor/ icense Holder
STATE OF FLORIDA ' � STATE OF FLO IDA
COUNTY OF J 1 LOC l COUNTY OF _CR
-pt L-)C
The�fo�r��oing instrument was acknowledget#before me The f r oing instr4 nt was cknowledged before me
this,,1,11 t day of_ 20! by this day of IL' _.i i C 20X by
._kk_Ce; Mcore� M ichod C"mA
Name of person making statement Name of per�qn making statement
Personally Known OR Produced Identification Personally Known i OR Produced Identification
Type of Identification Type of Identification
Produced Produced
VICTORIA JENKINS
(Signad c hof u is - State of Florida Si nat f Nota bA� of Flory
.,. A ion # GG 002527 ( g Notary
:?9—
)mmJ
Notary Public -State of Florida
+•F Pte: My Cnn YC °;;��°° B 'f� if fres Jun 14, 2020 Commission No. . _ Comp�(f t��11# GG 002527
Notary Assn. Pc My it
Of Jun 14, 2020
%°,,`, Bonded through National Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17