HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^
Date:- 0' `>' �� Permit Number: (�I
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RECEIVED
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Building Permit Application JAN 0 3 2019
Planning and Development Services ST. Lucie Count Permittin
By
Building and Code Regulation Division , g
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: Window/door
PROPOSED.IMPROVEMENT LQCATION
Address: o � {6� I n V- 'd e 9 I 'cam• 3 Liq
Legal Description: i f_
Property Tax ID M. ` j /'�! 'C2 p 'ate ^—7 Lot No.,123
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DES:CRIPTION'OF WORK ,s
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U1 CT INFORMATION g
Additional work toe e Orme under this permit—c ec a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �Q , ��� C7 Utilities:CnSewer ElSeptic Building Height:
OWNER%LESSEE ` CONTRACTOR
Nam - r^ Name: �YPt�1nlGzh
Address: P t 'rc,le Company: 2 If2 r K.-j-,Pr';nr5 . _TAC
City: i C-e- State:PL Address: I7r5i �li-Yrnb t� "
Zip Code: I Fax: City: -Ph L �21 Stater
Phone No. alb Q. S a Zip Code: 349�r Fax:
E-Mail: Phone No. -2_7D ' 3 -0(eC6
Fill in fee simple Title Holder on next page(if different E-Mail: bre—
from
the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPT MENTALICO 5Tl UIr 0101 .lElit L A St f fFORMATfOiV
DESiGNERANGINEER: 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 theermit 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,perforin 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:Vour 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.
Signaturejof Owner/Less /Contractor as Agent for Owner Signature of C6ntractor/UcerXe Holder
COLINNTTE OYeOFgoRIDAs' / t n C� COUNTOYOFORIDJ I �u C ce
The fo Ding instrument was acknowledged before me Theing instrument was acknowledged before me
this day of 76A\A ,26 LJ by this
forgoday of -3(M ,2Q-L9 by
Name of person Taking statement Name of persa along statement
Personally Known��/�pOR Produced Identification Personally Known Le-**'—. OR Produced Identification
Type of Identification Type of Identification
Pro iMV— P uc
(Signa re o y p (Sign tare o� r Public-S e�
Noiary Public$taie of Fiotida Notary Pubfl Stele of FI ds
Commission ,p` ane AthMMI) Commission QQ Ai eal)
" c My CommissionGG 820879 +� My commission GG 020879
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17