HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 �`d Permit Number:
Building Permit Applicatio AUG 33 `C;8
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 - /
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �C
PROPOSED IMPROVEMENT LOCATION
Address: g 6751e5 NcsT &- ,ft
Legal Description:
Property Tax ID#: 70a- O l U; •- GDO - 3 Lot No. a�
Site Plan Name: Block No. 63
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDESC ,OF
DRLPTION, ,WORK ,:.
AlL /Y /O 1/(-•W
CONSTRUCT,IQN 1N1=0RMATION
:Na wor to e errormed under this permit—cher a I that app
y:
HVAC Gas Tank Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers E]Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0_Sewer F Septic Building Height:
OWNER%LESSEE :CO"NTRACTOR .,
Name aAky !>'WAy / h0yv►g,J Name:�SQ�l. ✓L2
Address:c99 f/ Coft Company:S ' /-9 eA /fe97_1� f j4-/G
City:a 9- tyeyC State: F�1, Address: Cr f!3 PAS-6,!q �JC�
Zip Code: 3y9f a Fax: City: Ff• A,e/Ci.. State:
Phone No. ?7d - S'77 - 15-3'3 Zip Code: 3y�'�a Fax: 2?a- W-c2c214,
E-Mail: Phone No. 72,2- V& 7- 3 gad
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CA&lei S/ 71
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU.PPLEMENTACCONSTRUCTI'ON'LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: c/ 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.
01ature of Owner/Lessee/Contractor as Agent for Owner Sig a re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORaDA
COUNTY OF Sao. Ly c ee COUNTY OF
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this _�) day of <k J q ,20_ by this -1--j._day of Ay a 120-1 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ldentifLqation Type of Identification
Produced Produced t- L
(Signature of Not u ,S gIEGNENS. (Signature of Notary Pu bW
NgMpRIEGNENS��
022023 •�':::'? ,;
•''�"•••. ' My% 11SSION#GGpMMI$$ION#GG022023
Commission No. �`ti'$ :r Jp .Mber16,2020 Commission No. � mber16,2020
ndenvrllers °•
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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