HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO pMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: O Permit Number: 1�q
- REC:EIVED]
Building Permit Application
Planning and Development Services NOV 209Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie Cou_ � PePhone: (772)462-1553 Fax: (772)462-1578 Commercial X Residentla
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: O-6
Legal Descriptio 01,
d
Property Tax ID#: '!!)Q Lot No.
Site Plan Name: // Block No.
Project Nam&1J/�.B W4iU1 t�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -
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CONSTRUCTIONINFORMATION. 77]
Additional work to be nertormed under this permit–check all appy:
HVAC Gas Tank 0Gas Piping _Shutters Q Windows/Doors
®Electric 0 Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �/Apty, �0 Utilities:n Sewer Septic Building Height:
OWUNER/LESSEE:'-. CONTRACTOR-:-
Na
ONTRACTOR:Na a Name:
Address: 0 C4#1e' �941rutaJ Company: If CJ
City: State:. Address: �S'N3 X03- $
Zip Code: 3JJq q? Fax: State
Phone No. $LO.Io 04-8377 Zip Code: .3y9�15 Fax:
E-Mail: Phone No.972• �fG/X77?
Fill in fee simple Title Holder on next page(if different E-Mai1:/";eS it PQ;AL-
from the Owner listed above) State or County License: k4
s 87
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SIJP�LEI�IENTAHL C�NSTRl1 3TION LIEN'1:AW�IN�C)RMATIOI� ��� ��; ; �, � �" s �� � �`���
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X 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 thepermit 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 you intend to obtain financing, consult with lender or torney before
commenci,ng work or reeordiog your Notice of Commencement.
Si n ture of Owner L see Contractor as Agent for Owner Signa re of Contractor/Lcerlise Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5A-)oJ i /--� C1 6 COUNTY OF -SA-'til k-r�E
Thefor oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �� day of pdo Ue4464� 20ff by this I I day of OV6*45 (4- 2019 by
Name of per on making statement Name of persop making statement
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
U/L kc&,up-,) � �-G✓ Cep- -t�—�—�
(Signature of _ (Signature of Notary Public-State of Florida)
•�ti;r,•F•c.li���••,:MONICACASANA 1 .•Lot.
MONICACASAA
`Commission#GG O7 �I) "
ICommission N :. Com
Expires June 8,202 _ 73
sorRnTroyfnMwm800.385.1019 ExpiresJune8,2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
T I I I
Rev.8/2/17