HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Mf-
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Building Permit Application RECEIVED
Planning and Development Services ,IAN 11 2019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 1 ST. Lucie County, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I?ROrzPOSED IMPROVEMENTLOCATIORI�
Address: ® � 4W0.
Legal Description:
Property Tax ID#: T!FC_)6 — 0 3 —(X0 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTfON,OF WORK ,
�.
CONSTRU-CTION IN,1=0RMATION
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Additional"work to nGasTank
forme under this permit–check k a appy:
1:1
PElec11H AC E]Gas Piping _Generator 1:1 Roof Roof P Shutters ❑Windows/Doors
tric 1:1 Plumbing ❑S Plbin itch
— — prinklers ❑— — �
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ too Utilities:n Sewer Septic Building Height:
ESSE.rrE/Lw .= SC::,OROW,NER NtT
Name oinc,
gash✓ �,r Name: VV\e_S
Address: - _5 Company: C� ev- ib ' C
City: /�' � State:_ Addr s: � 7
Zip Code: Fax: City: �'a State:
Phone No. 7 7 — 2-7 Zip Code: Fax:
E-Mail: Phone No. 774– 766 73
Fill in fee simple Title Holder'on next page( if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION
.LIEN LAW INFORMATION..•
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 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. If you inten to obtytin financing, consult with lender or an attorney before
commencing work or record in air otice C mmencement.
Signat of Owner/Lessee/Contra or as Agent for Owner =FLO
Contractor/L' se der
LATE OF FLORID
COUNTY OF COUNTY OF
The fo going instr ment was acknowledge efore me The forgoing instr ment was acknowledged efore me
this day of, \P'K� by this day of20� by
® �.I
Name of perso aking statement / Name of person mak ng statement /
Personally Known OR Produced Identification V Personally Known OR Produced Identification r
Type of(dent' ' ion Type of Identificatian
Produced Produced I
r
(Signature of Notary Public-State of Florid (Signatur U lic-State of Florida)
iPflY PV11 'Ji
Commission No ,���Yo�� KAREN S.��l Sp Public Commiss ' state of r � s NIELS
=o f Florida -
207484 *=
+_ Commission # GG ;? oPc Commission a-Notary pubiio
;. My Commission Expires �Q�OF pW�
'� °� h'y CJ mmission ExOj 484
OF ple� 2 2022
REVIEWS RONT ZONING SUPERVISOR PLANS VEGETATION SEAT MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17