HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: r
E;5 9 -; RECEIVED -
Building Permit Application JAN 0 3 2019
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 _
PERMIT APPLICATION FOR: Shutter El
PROPOSED IMPROVEMENT LOCATION,:
Address: n r ,L /
Legal Description: gyral 001 p2e=aLI; ,
( Mal— 10Z�: 1605 .0 ( 370
Property Tax ID#: Z 6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION.
Additional work to be erformed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
��i
Electric ❑ Plurr�6ing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ IZ17X15 Utilities: 0_Sewer Septic Building Height:
OWNER/LESSEE'' CONTRACTOR';
Name 1,01 1\'-, �5 Name: )Pb°et'ho /1. T1 nsaj,
Address: 'li n Company:
City: State: Address: IZ-D! ylc)
Zip Code:_0Aq Fax: City: ,}17 L State:
Phone No. Zip Code: 3u�d�3 Fax:.-
E-Mail: Phone No `7703-V73 -e2&_f_,96
Fill in fee simple Title Holder on next page(if different E-Mail: � h,YP}C FGJ r�rS•GB/�-+
from the Owner listed above) State or County License: 6, e a_ 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INF,pRMATION
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.
r-- c
Signature f Owner/Less /Contractor as Agent for Owner Signature of C ntractor/Lice a Holder
STATE OF FLORIDA STATE OF FLORir
COUNTY OF C(I° COUNTY OF t�(440e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _day of �Ul ,20 by this�day of 20 by
nVl1U^
Name of person making statement —�^Name of person making statement
Personally Known OR Produced Identification Personally Known '-4— OR Produced Identification
Type of Iden ' 'cation Type of Identification
Prod d Pro ced
(Signature o 91►•AStRI'b� (Sig of Notary Public-State of Florida)
�pav A� Notary Public State of Florida '
Commission ' Joshua Shane AIbh4ft Commissi �ikO ft Notary Pubile State of Fiorld�e
�< < y elan OG oo�Zbb����AA J� ua an Alberico
of ted -Explres 08116/2020 a My Commission GG 020879
o►r'o
Expires 08/1812020
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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