HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED /�
Date: ! • a�• Permit Number: "/ t,7
RECETUED
-
' N222019
_ - - Building Permit AP;esidential
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Planning and Development Services
Building and code Regulation Division � itting Department
2300 Virginia Avenue,Fort Pierce FL 34982 Lucie C o u n ty .
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: eG�
P @P Ms€o INt"ROVEMENT LOCAT aN.
Address: 7 IO-51—
Legal Description:
PropertyTaxlD#: 3yC1a �Cabs�t� lay ,-aao 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA1,M DEMOIRiPTION OF VI/ORIC.
L'
C* NSTR+U'C"T,I I DNFORANEW
N:
Additional work to be pertormed un ,er this permit-check all that appy:
_oQMechanical _-Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
0 N�Rf LESSEE: Cf�NIT] U'4
Name . Name:
Address:. I-I4�4� _De Company: Mee -c-(?
c
City:�9� P�c,2�+.� 7�L StaterL Address:� Jzyii all
Zip Code:30 1 Fax: City: r •�,�O�GP _ State: Z—
Phone No. 77Z- Z 3�� 777 Z Zip Code: 2 Fax:
E-Mail: .ilre4e6 37'CoLF- G ��a� &v Phone No T7Z 9�9-27 c
Fill in fee simple Title Holder on next page(if different E-Mail •a'&\
from the Owner listed above) State or County License (e I Z5 0 2�7n
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
RU-MIA&VOTERTAIM INF4RMATlC+)N:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER:. —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,Wqrk or recorcHng your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contr ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTY OF �4 , LocOk
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
thisQ3, day of ;5qY\ ,20 1 \ by t h i ay of20 11 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi ation Type of Identification
Produced L ti— Produced V�'l, dQ C
(Signature of Notary P li f,FloridQ*NNA'
?` ' ' MY COMMISSION#GG 022023 r
MY COMMIS, 022023 (Signature of Nota P ate oJDA56 I"IE GIVENS
nber16,2020 =*;
Commission No.�ra� ••jFo;�oQH• Bo( No p�undenvfi1e ommission No. •� d�I�N�16,2020
tinea Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17