HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ]
Date: 01 ICA 11C( Permit Number:
RECEIVE®
Building Permit Applialtior JAN 10 2.019
Planning and'Development'5ervices
Building and Code'RegulationDivision Permittin epartment
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462=1578 Commercial . .�esStnflalcip2Coilnty, FL
PERMIT APPLICATION FOR: To Select from dropb x, click arrow at the end of line
PRO � k PLOCuTIO
Address: to
ailw& Lucie FL, 340o
Legal Description: lQraeS (_+ �G It VctICLD"e, .l P 15- 43 -3a f-�Me,' Q L D+ 4A
(oy, at ug-- q(09
Property Tax ID#: .3�331"— 50.) I17 0009 Lot No. 4A
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left.Side:
F g
yDETAILED DESCR1PTiON OF WRK� Sy � �
Latter Lt 1L-E CI CC_-1 ri G
Additional workto fjrt
Orme un ert is permit-c eca appy:0HVAC :GasTank ❑Gas Piping _Shutters ❑;Windows/Doors
l Electric Plumbing 0sprinklers Q Generator r-1 Roof' Roof pitch
Total Sq.Ft of.Construction: Sq.Ft.of First Floor:
ao
Cost of Construction:$ 2-ac) -" Utilities: _Sewer 11 Septic Building.Height:
oWE' - y t , oR
R�LESS�EEt� � z�, t,�� n tiC0 �Ry
N CTt
n
Name V—t OVICIf Qt- Q(- rC'15 Name:_'.�� ►I V CI
Address: qda8hL h+ Cf2C,ie Company: 'DCf964S 2CQ1 Sr�ltGEi
City: (# 5+.. Lo, _ State: F. Address: A-I'09 Coco(- Covey _ ory�e-
Zip Code: 3' L{'-(:0 Fax: nC� City: � r4 01-eroc State: �7,L
Phone No. B(o- 556. 3C?U-9 Zip Code: 3qq`�1 Fax: 1772. 3().15qZ
E-Mail: t)l Ck Phone No. �`�Z- '� ALO C7�
Fill in feesimple Title Holder on next page(if different E-Mail: hn.f CAA ell Iff U I LO 1 .00' 0-1
from.the Owner listed above) State or County License: C?G#"(Cl- C(0'7 J
If value of Construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONS7RUCTION LIEN LAW;INFOEtMATtON y
,f
DESIGNER/ENGINEER: "_.Not Applicable MORTGAGE COMPANY: Not Applicable.
Name: Name:
Ad d rens: Add ress:
City: State: City: State:
Zip: ,Phone zip: Phone:
,.FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: .,Not Applicable
11"Name: Name:
k! Address: Address:
:city: City:
Zip: Phone:. Zip: Phone:
OWNER/CONTRACTORAFFIDVIT:Application is hereby made to obtain a permitto 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 anyapplicable Horne Owners Association rules,bylaws or and covenants that may restrictor 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,swim.ming'pools,,fences,walls,signs,screen rooms and accessory uses toanother non-residential use
WARNING TO OWNER:Your failure to Record a Notice,of Commencement may result.in-yourpajiing twice for
improvements to your property.A Notice of Commencement:must b.e recorded and posted'on the.jobsite
before the,first inspection.If you intend to obtain financing,consult with lender oranattorney before.
commencing work or,recording.your Notice of Commencement.
CXt 4
i natur of Owner/Lessee/Contractor as Agent for Owner Signa =eCcritractor/License Holder
FLO JDA r STATEORIRA ` r
COUNTY OF I; 1 t;.X15 COUNTY OF. dT
The forg 'ng instrume was acknowledged before me The f r RIng instru� t was acknowledged before,me
this��day.of by this ]"day of 0 by
)Iasl J & ��___
Name of person making statement . % ---game ofperson making statement
Personally Known OR Produced Identification Personally Known OR Produced.identification
Type.of Iden i i a' Type ofidetifi- ti,
Produced 2 — Produced
1
{Signat ceofNot Pubh e,a orida} (Si patvreoENotary u fap�
p b3tas�1 rIT � k mrt mm P��5iate of F a
rt issionNo. ^��•. ea ;r,Tx,Are>�ro. . O
Commission No. ` ¢,� a'ats.ol iorca 2
F 8S5 ,li
Pei3.
v:s;FO.2 2020.1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATU'RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE '
COMPLETED
Rev.8/2/17