HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: gij �IY Permit Number: 63& /
RECEIVED
rte
COUNTY SEP fl 82019
F L O R I D A -
Building Permit Application Permitting Department
Planning and Development Services St, Lucie County
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
ENTnLOCATION�: I 1I�f'
Address: I UC �l A`"ltt, �l FA-. ?7 ereP, i ! _ 34"f-T9
Legal Descriptionsain ?ark , 'V) I (6� Li- 1 (Ara F,F, 1/2-1)-C- Li 1- 2_, (,,/,,i-'l K.,
Property Tax ID#: g‘,4 0551 - 00+V-000-A, Lot No.
Site Plan Name: \ - f `P- Si
Block No.
Project Name: VV ) 15o ' �� `de o
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Rroviae. and Inst&'\ c cc(r °q 5 ' I ' hI M ch c ►' ' \ fir ".Ci-''\f
''\f \-\-- I DD yc-e_
CONSTRUCTION INFORMATION: LL
Additional work to be performed under this permit-check all;ha apply:
HVAC _Gas Tank riGas Piping I Shutters ['Windows/Doors
0Electric ❑ Plumbing Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: 2 S . Ft. of First Floor:
Cost of Construction: $ 4, 31.09 , Utilities: _Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 12,c)----a_ 4 cJ i 5 'V.5\\son Name: \,,1U 11\xi'�''e.1
Address: • .�O 1% ,_ Company:D�( .i-\. t5 QJCf
City: 1 ,. I eX'C State:L. Address: \ . _ aqt
Zip Code:5'-‘6\1;r1 Fax: �2 City: % .0State:_,
Phone No. 3O. 1f --1 a .1.01 l31pg Zip Code: 1 Fax:
E-Mail: `*Dia, TIP.—5c64—— ( A.A5 Phone No. i -- �j♦
Fill in fee simple Title Holder on next page (if different E-Mail: 5 4 a4 • '.e. 1 _l. 1 -)
from the Owner listed above) State or County License: LoR Leo2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X 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.
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12
,�,,�Signaturke,4;4a Owner/Lessee/Contractor as Agent for Owner Sigriature of Contractor/License Holder
STATE OF FLORIDA i STATE OF FLORIDA _`1
COUNTY OF i1/1(is(-til,'1 COUNTY OF ��(J�' 1111
The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledge before me
this day of 5CPT' _ , 20 by this Ow day of , 20L6by
1fin\d cI310(QXre ,
Name of person making statement r Namoe`f pe son making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced V✓Lf 1.5 -13q q 5 to Produced
4/./f
UL �
(Signature of Notary Pu.lic-State of Florida) (Signature o#. y Publimaativitiieigo)
Richard F.McDermott '"'
s': •' MY COMMISSION S FF 760
Commission No. PUBLIC Commissioobei= X44 ��I)
Co:,18.:(ENdTARY
tSTATE OF FLORIDA ISO?)3 8-0.53 Fbridallotsryikrrine.enm
'""`-" Cann#06180414
Ex fres 1/29/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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